UMA ANDERSON
Dependent on policy B03M000733
Claims
2
Attributed to this person
Charged
834.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
187.85
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 | UMA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000733 |
| Date of birth | 1 Apr 2009 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 187.85 |
| Total | 187.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003065 | 25 Oct 2024 | 289.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003066 | 25 Mar 2024 | 545.00 | MERIDIAN HEALTH PLAN | Not denied | — |