NADIA SMITH
Dependent on policy B09M000609
Claims
2
Attributed to this person
Charged
762.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
138.80
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 | NADIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000609 |
| Date of birth | 10 Jan 1952 |
| Plan | PLATINUM PPO |
| Covered from | 25 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 138.80 |
| Total | 138.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002566 | 16 Apr 2025 | 68.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002565 | 1 Mar 2025 | 694.00 | MERIDIAN HEALTH PLAN | Not denied | — |