ZARA HUGHES
Subscriber on policy B03M000515
Claims
3
Attributed to this person
Charged
1,449.00
Total submitted
Denied
612.00
1 denied claims
Patient responsibility
50.00
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 | ZARA HUGHES |
| Role on the policy | Subscriber |
| Policy | B03M000515 |
| Date of birth | 27 Nov 1999 |
| Plan | PLATINUM PPO |
| Covered from | 11 Sep 2024 |
| Covered to | 4 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002115 | 23 Dec 2024 | 369.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002113 | 16 Nov 2024 | 468.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002114 | 9 Sep 2024 | 612.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 612.00 |