AMARA USMAN
Dependent on policy B04M000416
Claims
2
Attributed to this person
Charged
812.00
Total submitted
Denied
456.00
1 denied claims
Patient responsibility
20.00
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 | AMARA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000416 |
| Date of birth | 11 Aug 1970 |
| Plan | GOLD PPO |
| Covered from | 21 Feb 2025 |
| Covered to | 5 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001784 | 1 Feb 2026 | 356.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001785 | 1 Feb 2025 | 456.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 456.00 |