WENDY SMITH
Dependent on policy B07M000699
Claims
3
Attributed to this person
Charged
2,069.00
Total submitted
Denied
790.00
1 denied claims
Patient responsibility
100.60
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 | WENDY SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000699 |
| Date of birth | 8 May 2019 |
| Plan | BRONZE EPO |
| Covered from | 3 Jun 2025 |
| Covered to | 17 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 100.60 |
| Total | 100.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002895 | 25 Sep 2025 | 790.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 790.00 |
| CLM0002894 | 6 Sep 2025 | 503.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002893 | 19 Jun 2025 | 776.00 | MERIDIAN HEALTH PLAN | Not denied | — |