GRACE USMAN
Dependent on policy B04M000793
Claims
3
Attributed to this person
Charged
786.00
Total submitted
Denied
298.00
1 denied claims
Patient responsibility
14.25
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 | GRACE USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000793 |
| Date of birth | 20 May 1984 |
| Plan | PLATINUM PPO |
| Covered from | 6 Feb 2024 |
| Covered to | 6 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 14.25 |
| Total | 14.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003466 | 27 Apr 2024 | 298.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 298.00 |
| CLM0003465 | 9 Feb 2024 | 393.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003467 | 1 Feb 2024 | 95.00 | MERIDIAN HEALTH PLAN | Not denied | — |