YUSUF SMITH
Subscriber on policy B06M000724
Claims
2
Attributed to this person
Charged
1,329.00
Total submitted
Denied
825.00
1 denied claims
Patient responsibility
15.00
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 | YUSUF SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000724 |
| Date of birth | 7 Aug 1965 |
| Plan | PLATINUM PPO |
| Covered from | 10 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003235 | 26 Sep 2025 | 504.00 | CASCADE CARE | Not denied | — |
| CLM0003234 | 26 Dec 2024 | 825.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 825.00 |