HENRY REYES
Dependent on policy B04M000177
Claims
1
Attributed to this person
Charged
332.00
Total submitted
Denied
117.32
1 denied claims
Patient responsibility
0.00
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 | HENRY REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000177 |
| Date of birth | 28 Jul 1974 |
| Plan | BRONZE EPO |
| Covered from | 17 Apr 2024 |
| Covered to | 19 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000805 | 20 May 2024 | 332.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 117.32 |