DAVID SMITH
Subscriber on policy B01M000466
Claims
3
Attributed to this person
Charged
1,121.00
Total submitted
Denied
521.00
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 | DAVID SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000466 |
| Date of birth | 27 Jun 1972 |
| Plan | PLATINUM PPO |
| Covered from | 29 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002079 | 24 Apr 2026 | 129.00 | CASCADE CARE | Not denied | — |
| CLM0002078 | 2 Aug 2025 | 521.00 | CASCADE CARE | CARC 11 · CODING | 521.00 |
| CLM0002080 | 27 May 2025 | 471.00 | CASCADE CARE | Not denied | — |