LEILA SMITH
Subscriber on policy B08M000863
Claims
3
Attributed to this person
Charged
1,339.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
111.80
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 | LEILA SMITH |
| Role on the policy | Subscriber |
| Policy | B08M000863 |
| Date of birth | 7 Apr 1983 |
| Plan | PLATINUM PPO |
| Covered from | 28 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 111.80 |
| Total | 111.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003861 | 12 Nov 2025 | 566.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003862 | 7 Sep 2025 | 214.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003863 | 4 Jul 2025 | 559.00 | MERIDIAN HEALTH PLAN | Not denied | — |