GRACE HUGHES
Subscriber on policy B04M000846
Claims
3
Attributed to this person
Charged
1,444.00
Total submitted
Denied
838.10
2 denied claims
Patient responsibility
83.85
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 HUGHES |
| Role on the policy | Subscriber |
| Policy | B04M000846 |
| Date of birth | 5 Jul 1969 |
| Plan | BRONZE EPO |
| Covered from | 27 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 83.85 |
| Total | 83.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003654 | 5 Dec 2025 | 62.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 15.10 |
| CLM0003652 | 29 Nov 2025 | 559.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003653 | 7 Dec 2024 | 823.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 823.00 |