FIONA SMITH
Subscriber on policy B09M000647
Claims
2
Attributed to this person
Charged
1,379.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
141.00
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 | FIONA SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000647 |
| Date of birth | 8 May 1956 |
| Plan | PLATINUM PPO |
| Covered from | 17 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 141.00 |
| Total | 141.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002746 | 25 Aug 2026 | 674.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002745 | 16 Feb 2025 | 705.00 | MERIDIAN HEALTH PLAN | Not denied | — |