ELENA SMITH
Dependent on policy B06M000687
Claims
3
Attributed to this person
Charged
1,638.00
Total submitted
Denied
802.00
2 denied claims
Patient responsibility
131.30
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 | ELENA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000687 |
| Date of birth | 9 Aug 2023 |
| Plan | GOLD PPO |
| Covered from | 18 Jun 2025 |
| Covered to | 25 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 131.30 |
| Total | 131.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003069 | 13 Jan 2026 | 802.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 802.00 |
| CLM0003067 | 27 Aug 2025 | 634.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003068 | 22 Jun 2025 | 202.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |