GRACE SMITH
Subscriber on policy B09M000786
Claims
2
Attributed to this person
Charged
260.00
Total submitted
Denied
52.75
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 | Subscriber |
| Policy | B09M000786 |
| Date of birth | 19 Jun 1965 |
| Plan | SILVER HMO |
| Covered from | 1 Apr 2025 |
| Covered to | 6 Oct 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 |
|---|---|---|---|---|---|
| CLM0003319 | 26 Sep 2025 | 141.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003318 | 2 May 2025 | 119.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 52.75 |