GRACE PATEL
Dependent on policy B03M000429
Claims
1
Attributed to this person
Charged
779.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.85
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | GRACE PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000429 |
| Date of birth | 14 Oct 2017 |
| Plan | GOLD PPO |
| Covered from | 6 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.85 |
| Total | 116.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001749 | 19 Feb 2026 | 779.00 | MERIDIAN HEALTH PLAN | Not denied | — |