UMA ANDERSON
Dependent on policy B05M000574
Claims
1
Attributed to this person
Charged
192.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
28.80
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 | UMA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000574 |
| Date of birth | 26 Feb 1981 |
| Plan | GOLD PPO |
| Covered from | 28 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 28.80 |
| Total | 28.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002445 | 25 Jan 2025 | 192.00 | MERIDIAN HEALTH PLAN | Not denied | — |