TOMAS SMITH
Dependent on policy B08M000408
Claims
3
Attributed to this person
Charged
1,304.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
10.20
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 | TOMAS SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000408 |
| Date of birth | 6 Jul 1962 |
| Plan | BRONZE EPO |
| Covered from | 28 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 10.20 |
| Total | 10.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001876 | 28 Feb 2026 | 579.00 | CASCADE CARE | Not denied | — |
| CLM0001877 | 25 May 2025 | 68.00 | CASCADE CARE | Not denied | — |
| CLM0001878 | 5 May 2025 | 657.00 | CASCADE CARE | Not denied | — |