HENRY IQBAL
Dependent on policy B05M000848
Claims
3
Attributed to this person
Charged
1,199.00
Total submitted
Denied
86.00
2 denied claims
Patient responsibility
408.15
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 IQBAL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000848 |
| Date of birth | 18 Sep 1989 |
| Plan | PLATINUM PPO |
| Covered from | 31 Aug 2024 |
| Covered to | 24 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 358.15 |
| CARC 3 · Copay | 1 | 50.00 |
| Total | 408.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003597 | 17 Sep 2024 | 562.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003598 | 17 Aug 2024 | 551.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0003596 | 8 Aug 2024 | 86.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 86.00 |