JULIA REYES
Dependent on policy B04M000712
Claims
3
Attributed to this person
Charged
1,629.00
Total submitted
Denied
424.00
1 denied claims
Patient responsibility
109.35
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 | JULIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000712 |
| Date of birth | 22 Nov 1985 |
| Plan | BRONZE EPO |
| Covered from | 18 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 109.35 |
| Total | 109.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003097 | 25 Nov 2024 | 476.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003095 | 6 Nov 2024 | 424.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 424.00 |
| CLM0003096 | 27 Jun 2024 | 729.00 | MERIDIAN HEALTH PLAN | Not denied | — |