CARLA SMITH
Subscriber on policy B08M000242
Claims
3
Attributed to this person
Charged
1,243.00
Total submitted
Denied
720.00
1 denied claims
Patient responsibility
15.00
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 | CARLA SMITH |
| Role on the policy | Subscriber |
| Policy | B08M000242 |
| Date of birth | 8 Nov 1961 |
| Plan | PLATINUM PPO |
| Covered from | 14 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001087 | 8 Jul 2025 | 75.00 | CASCADE CARE | Not denied | — |
| CLM0001086 | 29 Mar 2025 | 448.00 | CASCADE CARE | Not denied | — |
| CLM0001088 | 4 Mar 2025 | 720.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 720.00 |