LEILA SMITH
Dependent on policy B08M000138
Claims
2
Attributed to this person
Charged
337.00
Total submitted
Denied
171.00
1 denied claims
Patient responsibility
0.00
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 | LEILA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000138 |
| Date of birth | 26 May 1984 |
| Plan | BRONZE EPO |
| Covered from | 7 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000626 | 27 Apr 2026 | 166.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000627 | 6 Nov 2025 | 171.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 171.00 |