WENDY SMITH
Dependent on policy B08M000396
Claims
3
Attributed to this person
Charged
1,550.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
35.20
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 | WENDY SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000396 |
| Date of birth | 4 Jan 2002 |
| Plan | GOLD PPO |
| Covered from | 17 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 35.20 |
| Total | 35.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001810 | 14 Mar 2026 | 749.00 | CASCADE CARE | Not denied | — |
| CLM0001811 | 14 Nov 2025 | 176.00 | CASCADE CARE | Not denied | — |
| CLM0001812 | 14 Feb 2025 | 625.00 | CASCADE CARE | Not denied | — |