HENRY SMITH
Dependent on policy B08M000373
Claims
1
Attributed to this person
Charged
388.00
Total submitted
Denied
388.00
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 | HENRY SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000373 |
| Date of birth | 29 Jan 1992 |
| Plan | SILVER HMO |
| 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 |
|---|---|---|---|---|---|
| CLM0001704 | 23 Mar 2026 | 388.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 388.00 |