DAVID QUINN
Subscriber on policy B04M000268
Claims
2
Attributed to this person
Charged
435.00
Total submitted
Denied
290.00
1 denied claims
Patient responsibility
15.00
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 | DAVID QUINN |
| Role on the policy | Subscriber |
| Policy | B04M000268 |
| Date of birth | 25 Jan 1963 |
| Plan | PLATINUM PPO |
| Covered from | 30 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001154 | 30 May 2026 | 290.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 290.00 |
| CLM0001153 | 30 Aug 2025 | 145.00 | MERIDIAN HEALTH PLAN | Not denied | — |