AMARA SMITH
Dependent on policy B08M000201
Claims
1
Attributed to this person
Charged
70.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 19 |
| Policy | B08M000201 |
| Date of birth | 30 Oct 2022 |
| Plan | PLATINUM PPO |
| Covered from | 21 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000895 | 12 Aug 2026 | 70.00 | MERIDIAN HEALTH PLAN | Not denied | — |