VICTOR USMAN
Subscriber on policy B05M000303
Claims
2
Attributed to this person
Charged
977.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
291.20
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 | VICTOR USMAN |
| Role on the policy | Subscriber |
| Policy | B05M000303 |
| Date of birth | 14 Oct 1966 |
| Plan | SILVER HMO |
| Covered from | 16 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 291.20 |
| Total | 291.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001257 | 18 May 2026 | 448.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001258 | 26 Aug 2025 | 529.00 | MERIDIAN HEALTH PLAN | Not denied | — |