VICTOR PATEL
Subscriber on policy B03M000612
Claims
2
Attributed to this person
Charged
1,176.00
Total submitted
Denied
196.62
1 denied claims
Patient responsibility
149.40
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 | VICTOR PATEL |
| Role on the policy | Subscriber |
| Policy | B03M000612 |
| Date of birth | 25 Apr 1984 |
| Plan | BRONZE EPO |
| Covered from | 23 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 149.40 |
| Total | 149.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002514 | 18 Oct 2024 | 747.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002513 | 6 Apr 2024 | 429.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 196.62 |