LEILA REYES
Dependent on policy B01M000724
Claims
2
Attributed to this person
Charged
139.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
9.00
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 | LEILA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000724 |
| Date of birth | 12 Jan 1974 |
| Plan | BRONZE EPO |
| Covered from | 28 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 9.00 |
| Total | 9.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003222 | 28 Jun 2026 | 79.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003223 | 19 Apr 2026 | 60.00 | MERIDIAN HEALTH PLAN | Not denied | — |