YUSUF PATEL
Subscriber on policy B05M000193
Claims
2
Attributed to this person
Charged
767.00
Total submitted
Denied
215.00
2 denied claims
Patient responsibility
358.80
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 | YUSUF PATEL |
| Role on the policy | Subscriber |
| Policy | B05M000193 |
| Date of birth | 8 Dec 1986 |
| Plan | GOLD PPO |
| Covered from | 5 Mar 2025 |
| Covered to | 6 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 358.80 |
| Total | 358.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000811 | 5 Apr 2025 | 215.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 215.00 |
| CLM0000810 | 20 Feb 2025 | 552.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |