DAVID HUGHES
Subscriber on policy B04M000703
Claims
2
Attributed to this person
Charged
489.00
Total submitted
Denied
407.74
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 | DAVID HUGHES |
| Role on the policy | Subscriber |
| Policy | B04M000703 |
| Date of birth | 7 Jun 1997 |
| Plan | PLATINUM PPO |
| Covered from | 13 Aug 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003054 | 22 Oct 2024 | 135.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 53.74 |
| CLM0003055 | 15 Sep 2024 | 354.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 354.00 |