ZARA KUMAR
Dependent on policy B01M000128
Claims
1
Attributed to this person
Charged
571.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
114.20
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 | ZARA KUMAR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000128 |
| Date of birth | 6 Feb 1984 |
| Plan | SILVER HMO |
| Covered from | 22 Apr 2024 |
| Covered to | 16 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 114.20 |
| Total | 114.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000511 | 14 Oct 2024 | 571.00 | MERIDIAN HEALTH PLAN | Not denied | — |