CARLA ANDERSON
Dependent on policy B05M000122
Claims
2
Attributed to this person
Charged
1,574.00
Total submitted
Denied
700.00
2 denied claims
Patient responsibility
568.10
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 | CARLA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000122 |
| Date of birth | 10 Jul 1987 |
| Plan | PLATINUM PPO |
| Covered from | 15 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 568.10 |
| Total | 568.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000514 | 16 Aug 2025 | 700.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 700.00 |
| CLM0000513 | 13 Jun 2025 | 874.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |