ELENA SMITH
Subscriber on policy B08M000138
Claims
3
Attributed to this person
Charged
1,674.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
93.20
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 | ELENA SMITH |
| Role on the policy | Subscriber |
| Policy | B08M000138 |
| Date of birth | 7 Aug 1962 |
| Plan | BRONZE EPO |
| Covered from | 7 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 93.20 |
| Total | 93.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000622 | 30 Jul 2026 | 353.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000621 | 11 Sep 2025 | 855.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000620 | 8 Jul 2025 | 466.00 | NORTHSTAR MUTUAL | Not denied | — |