LEILA USMAN
Dependent on policy B04M000690
Claims
2
Attributed to this person
Charged
944.00
Total submitted
Denied
771.00
1 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 | LEILA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000690 |
| Date of birth | 2 Apr 1988 |
| Plan | BRONZE EPO |
| Covered from | 24 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 |
|---|---|---|---|---|---|
| CLM0003004 | 23 Dec 2025 | 771.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 771.00 |
| CLM0003005 | 20 Sep 2025 | 173.00 | MERIDIAN HEALTH PLAN | Not denied | — |