MARCUS SMITH
Dependent on policy B06M000677
Claims
2
Attributed to this person
Charged
1,521.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
127.40
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 | MARCUS SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000677 |
| Date of birth | 31 Aug 1986 |
| Plan | SILVER HMO |
| Covered from | 22 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 127.40 |
| Total | 127.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003008 | 18 Apr 2026 | 637.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003007 | 4 Apr 2025 | 884.00 | NORTHSTAR MUTUAL | Not denied | — |