SOFIA USMAN
Dependent on policy B04M000416
Claims
2
Attributed to this person
Charged
1,398.00
Total submitted
Denied
870.71
2 denied claims
Patient responsibility
0.00
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 | SOFIA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000416 |
| Date of birth | 20 Sep 1991 |
| Plan | GOLD PPO |
| Covered from | 21 Feb 2025 |
| Covered to | 5 Dec 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001789 | 5 Oct 2025 | 709.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 709.00 |
| CLM0001788 | 5 Jun 2025 | 689.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 161.71 |