TOMAS ANDERSON
Dependent on policy B04M000404
Claims
3
Attributed to this person
Charged
2,309.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
238.55
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000404 |
| Date of birth | 27 Oct 1982 |
| Plan | GOLD PPO |
| Covered from | 23 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 133.35 |
| CARC 2 · Coinsurance | 1 | 105.20 |
| Total | 238.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001733 | 27 Feb 2026 | 526.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001731 | 18 Dec 2025 | 889.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001732 | 2 Sep 2025 | 894.00 | MERIDIAN HEALTH PLAN | Not denied | — |