MARCUS SMITH
Dependent on policy B06M000628
Claims
3
Attributed to this person
Charged
1,078.00
Total submitted
Denied
200.63
2 denied claims
Patient responsibility
85.80
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 | B06M000628 |
| Date of birth | 21 Jan 1947 |
| Plan | GOLD PPO |
| Covered from | 17 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 85.80 |
| Total | 85.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002806 | 5 Sep 2025 | 132.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002805 | 4 Oct 2024 | 441.00 | CASCADE CARE | Not denied | — |
| CLM0002807 | 18 Apr 2024 | 505.00 | CASCADE CARE | CARC 18 · DUPLICATE | 200.63 |