HENRY YAMADA
Dependent on policy B05M000401
Claims
2
Attributed to this person
Charged
1,046.00
Total submitted
Denied
228.93
1 denied claims
Patient responsibility
25.00
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 | HENRY YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000401 |
| Date of birth | 7 Feb 1961 |
| Plan | GOLD PPO |
| Covered from | 2 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001710 | 14 May 2026 | 663.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 228.93 |
| CLM0001709 | 9 Apr 2025 | 383.00 | MERIDIAN HEALTH PLAN | Not denied | — |