SOFIA ANDERSON
Subscriber on policy B04M000207
Claims
1
Attributed to this person
Charged
662.00
Total submitted
Denied
662.00
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 | SOFIA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B04M000207 |
| Date of birth | 3 Nov 1957 |
| Plan | GOLD PPO |
| Covered from | 25 Sep 2024 |
| Covered to | 19 Dec 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 |
|---|---|---|---|---|---|
| CLM0000915 | 21 Jan 2025 | 662.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 662.00 |