AMARA SMITH
Dependent on policy B07M000699
Claims
2
Attributed to this person
Charged
876.00
Total submitted
Denied
876.00
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 | AMARA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000699 |
| Date of birth | 17 Apr 1996 |
| Plan | BRONZE EPO |
| Covered from | 3 Jun 2025 |
| Covered to | 17 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002891 | 25 Sep 2025 | 799.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 799.00 |
| CLM0002892 | 17 May 2025 | 77.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 77.00 |