JULIA SMITH
Subscriber on policy B07M000394
Claims
3
Attributed to this person
Charged
1,523.00
Total submitted
Denied
231.00
2 denied claims
Patient responsibility
437.45
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 | JULIA SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000394 |
| Date of birth | 10 Mar 1971 |
| Plan | PLATINUM PPO |
| Covered from | 15 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 437.45 |
| Total | 437.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001673 | 25 Feb 2025 | 619.00 | CASCADE CARE | Not denied | — |
| CLM0001674 | 9 Dec 2024 | 231.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 231.00 |
| CLM0001675 | 25 Jul 2024 | 673.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |