CARLA REYES
Dependent on policy B03M000854
Claims
3
Attributed to this person
Charged
1,474.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
205.40
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 | CARLA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000854 |
| Date of birth | 8 Dec 2007 |
| Plan | PLATINUM PPO |
| Covered from | 8 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 205.40 |
| Total | 205.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003701 | 17 Aug 2025 | 612.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003702 | 5 Aug 2024 | 316.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0003700 | 1 Apr 2024 | 546.00 | MERIDIAN HEALTH PLAN | Not denied | — |