CARLA SMITH
Subscriber on policy B06M000680
Claims
3
Attributed to this person
Charged
2,070.00
Total submitted
Denied
767.00
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 | CARLA SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000680 |
| Date of birth | 3 Nov 1965 |
| Plan | BRONZE EPO |
| Covered from | 22 Aug 2024 |
| Covered to | 23 Feb 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 |
|---|---|---|---|---|---|
| CLM0003022 | 1 Mar 2025 | 843.00 | CASCADE CARE | Not denied | — |
| CLM0003023 | 24 Feb 2025 | 767.00 | CASCADE CARE | CARC 18 · DUPLICATE | 767.00 |
| CLM0003021 | 14 Sep 2024 | 460.00 | CASCADE CARE | Not denied | — |