ELENA ANDERSON
Dependent on policy B06M000550
Claims
2
Attributed to this person
Charged
715.00
Total submitted
Denied
425.00
2 denied claims
Patient responsibility
188.50
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 | ELENA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000550 |
| Date of birth | 11 Jul 2017 |
| Plan | PLATINUM PPO |
| Covered from | 17 Apr 2025 |
| Covered to | 5 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 188.50 |
| Total | 188.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002463 | 28 Oct 2025 | 425.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 425.00 |
| CLM0002464 | 21 Sep 2025 | 290.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |