GRACE SMITH
Dependent on policy B08M000396
Claims
1
Attributed to this person
Charged
137.00
Total submitted
Denied
137.00
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 | GRACE SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000396 |
| Date of birth | 2 Jun 1994 |
| Plan | GOLD PPO |
| Covered from | 17 Jan 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 |
|---|---|---|---|---|---|
| CLM0001813 | 15 Jan 2025 | 137.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 137.00 |