ZARA USMAN
Subscriber on policy B04M000690
Claims
2
Attributed to this person
Charged
785.00
Total submitted
Denied
578.00
1 denied claims
Patient responsibility
31.05
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 | ZARA USMAN |
| Role on the policy | Subscriber |
| Policy | B04M000690 |
| Date of birth | 27 Aug 1978 |
| Plan | BRONZE EPO |
| Covered from | 24 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.05 |
| Total | 31.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003003 | 15 Dec 2025 | 207.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003002 | 20 Aug 2025 | 578.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 578.00 |