DAVID SMITH
Subscriber on policy B09M000811
Claims
3
Attributed to this person
Charged
2,356.00
Total submitted
Denied
758.00
1 denied claims
Patient responsibility
162.60
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 | DAVID SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000811 |
| Date of birth | 27 May 1952 |
| Plan | GOLD PPO |
| Covered from | 2 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 162.60 |
| Total | 162.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003441 | 2 Mar 2026 | 785.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003442 | 12 Feb 2026 | 758.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 758.00 |
| CLM0003443 | 11 Jun 2025 | 813.00 | MERIDIAN HEALTH PLAN | Not denied | — |