ELENA SMITH
Subscriber on policy B07M000229
Claims
2
Attributed to this person
Charged
676.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.80
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 | ELENA SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000229 |
| Date of birth | 30 Aug 1968 |
| Plan | SILVER HMO |
| Covered from | 2 Jul 2024 |
| Covered to | 16 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 40.80 |
| Total | 40.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000967 | 2 Dec 2024 | 472.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000966 | 19 Nov 2024 | 204.00 | MERIDIAN HEALTH PLAN | Not denied | — |