DAVID SMITH
Dependent on policy B01M000681
Claims
1
Attributed to this person
Charged
456.00
Total submitted
Denied
456.00
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 | DAVID SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000681 |
| Date of birth | 11 Aug 1960 |
| Plan | GOLD PPO |
| Covered from | 12 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003056 | 21 Mar 2024 | 456.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 456.00 |