ELENA SMITH
Subscriber on policy B06M000875
Claims
3
Attributed to this person
Charged
1,445.00
Total submitted
Denied
971.20
2 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 | ELENA SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000875 |
| Date of birth | 12 Oct 1965 |
| Plan | SILVER HMO |
| Covered from | 22 May 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 |
|---|---|---|---|---|---|
| CLM0003810 | 27 Apr 2026 | 197.00 | CASCADE CARE | Not denied | — |
| CLM0003811 | 26 Apr 2026 | 764.00 | CASCADE CARE | CARC 96 · NON_COVERED | 764.00 |
| CLM0003809 | 21 Jan 2025 | 484.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 207.20 |