MARCUS SMITH
Dependent on policy B07M000229
Claims
2
Attributed to this person
Charged
1,084.00
Total submitted
Denied
0.00
0 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 | MARCUS SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000229 |
| Date of birth | 7 Feb 2012 |
| Plan | SILVER HMO |
| Covered from | 2 Jul 2024 |
| Covered to | 16 Mar 2025 |
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 |
|---|---|---|---|---|---|
| CLM0000972 | 21 Oct 2024 | 402.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000971 | 25 Aug 2024 | 682.00 | MERIDIAN HEALTH PLAN | Not denied | — |