RAVI REYES
Subscriber on policy B04M000434
Claims
1
Attributed to this person
Charged
234.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | RAVI REYES |
| Role on the policy | Subscriber |
| Policy | B04M000434 |
| Date of birth | 11 Nov 1996 |
| Plan | GOLD PPO |
| Covered from | 29 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001872 | 12 Nov 2025 | 234.00 | MERIDIAN HEALTH PLAN | Not denied | — |