TOMAS KUMAR
Dependent on policy B01M000755
Claims
1
Attributed to this person
Charged
251.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
163.15
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 | TOMAS KUMAR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000755 |
| Date of birth | 27 Dec 1942 |
| Plan | BRONZE EPO |
| Covered from | 2 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 163.15 |
| Total | 163.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003361 | 11 Jul 2025 | 251.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |