HENRY SMITH
Subscriber on policy B07M000131
Claims
3
Attributed to this person
Charged
1,361.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
82.20
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 | HENRY SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000131 |
| Date of birth | 27 Nov 1964 |
| Plan | GOLD PPO |
| Covered from | 3 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 82.20 |
| Total | 82.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000548 | 15 Aug 2025 | 598.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000546 | 19 Apr 2025 | 215.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000547 | 1 Dec 2024 | 548.00 | MERIDIAN HEALTH PLAN | Not denied | — |