GRACE PATEL
Subscriber on policy B06M000158
Claims
3
Attributed to this person
Charged
1,350.00
Total submitted
Denied
525.27
2 denied claims
Patient responsibility
57.30
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 | GRACE PATEL |
| Role on the policy | Subscriber |
| Policy | B06M000158 |
| Date of birth | 5 Aug 1970 |
| Plan | GOLD PPO |
| Covered from | 1 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 57.30 |
| Total | 57.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000785 | 1 Feb 2025 | 248.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 248.00 |
| CLM0000786 | 29 Nov 2024 | 720.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 277.27 |
| CLM0000784 | 24 Nov 2024 | 382.00 | MERIDIAN HEALTH PLAN | Not denied | — |