OMAR SMITH
Dependent on policy B08M000835
Claims
3
Attributed to this person
Charged
1,453.00
Total submitted
Denied
758.00
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 | OMAR SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000835 |
| Date of birth | 25 Mar 2001 |
| Plan | PLATINUM PPO |
| Covered from | 23 Nov 2024 |
| Covered to | 22 Jun 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003723 | 27 Jul 2025 | 758.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 758.00 |
| CLM0003725 | 24 Feb 2025 | 598.00 | CASCADE CARE | Not denied | — |
| CLM0003724 | 18 Dec 2024 | 97.00 | CASCADE CARE | Not denied | — |