ELENA QUINN
Subscriber on policy B04M000520
Claims
2
Attributed to this person
Charged
874.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
445.90
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 | ELENA QUINN |
| Role on the policy | Subscriber |
| Policy | B04M000520 |
| Date of birth | 31 Jul 1972 |
| Plan | GOLD PPO |
| Covered from | 21 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 445.90 |
| Total | 445.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002255 | 24 Nov 2025 | 686.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002256 | 4 Feb 2025 | 188.00 | MERIDIAN HEALTH PLAN | Not denied | — |