ZARA REYES
Subscriber on policy B04M000783
Claims
3
Attributed to this person
Charged
1,719.00
Total submitted
Denied
874.00
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 | ZARA REYES |
| Role on the policy | Subscriber |
| Policy | B04M000783 |
| Date of birth | 29 Sep 1994 |
| Plan | GOLD PPO |
| Covered from | 9 Apr 2024 |
| Covered to | 16 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003417 | 10 Aug 2024 | 874.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 874.00 |
| CLM0003416 | 29 May 2024 | 687.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003415 | 12 May 2024 | 158.00 | MERIDIAN HEALTH PLAN | Not denied | — |