JULIA SMITH
Dependent on policy B09M000891
Claims
2
Attributed to this person
Charged
711.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
41.10
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 | JULIA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000891 |
| Date of birth | 22 Aug 2000 |
| Plan | BRONZE EPO |
| Covered from | 21 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 41.10 |
| Total | 41.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003801 | 4 Aug 2026 | 437.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003803 | 7 Apr 2026 | 274.00 | MERIDIAN HEALTH PLAN | Not denied | — |