YUSUF USMAN
Subscriber on policy B04M000411
Claims
1
Attributed to this person
Charged
569.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | YUSUF USMAN |
| Role on the policy | Subscriber |
| Policy | B04M000411 |
| Date of birth | 11 Mar 1958 |
| Plan | GOLD PPO |
| Covered from | 29 May 2025 |
| Covered to | 16 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001757 | 13 Jun 2025 | 569.00 | MERIDIAN HEALTH PLAN | Not denied | — |