ELENA KUMAR
Dependent on policy B04M000304
Claims
1
Attributed to this person
Charged
815.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
529.75
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 | ELENA KUMAR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000304 |
| Date of birth | 20 Oct 1983 |
| Plan | SILVER HMO |
| Covered from | 20 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 529.75 |
| Total | 529.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001328 | 23 Apr 2026 | 815.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |