GRACE ANDERSON
Dependent on policy B04M000458
Claims
2
Attributed to this person
Charged
956.00
Total submitted
Denied
956.00
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 | GRACE ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000458 |
| Date of birth | 10 Nov 1980 |
| Plan | SILVER HMO |
| Covered from | 3 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001958 | 10 Oct 2025 | 581.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 581.00 |
| CLM0001959 | 4 Sep 2025 | 375.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 375.00 |