OMAR SMITH
Dependent on policy B06M000687
Claims
2
Attributed to this person
Charged
885.00
Total submitted
Denied
636.00
1 denied claims
Patient responsibility
0.00
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 | OMAR SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000687 |
| Date of birth | 27 Feb 2003 |
| Plan | GOLD PPO |
| Covered from | 18 Jun 2025 |
| Covered to | 25 Nov 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003066 | 5 Dec 2025 | 636.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 636.00 |
| CLM0003065 | 5 Jun 2025 | 249.00 | MERIDIAN HEALTH PLAN | Not denied | — |