FIONA YAMADA
Subscriber on policy B05M000422
Claims
2
Attributed to this person
Charged
963.00
Total submitted
Denied
133.00
1 denied claims
Patient responsibility
124.50
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 | FIONA YAMADA |
| Role on the policy | Subscriber |
| Policy | B05M000422 |
| Date of birth | 24 Nov 1969 |
| Plan | PLATINUM PPO |
| Covered from | 17 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 124.50 |
| Total | 124.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001776 | 8 Mar 2025 | 133.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 133.00 |
| CLM0001777 | 11 Jan 2025 | 830.00 | MERIDIAN HEALTH PLAN | Not denied | — |