JULIA SMITH
Subscriber on policy B09M000025
Claims
2
Attributed to this person
Charged
1,044.00
Total submitted
Denied
580.31
2 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 | JULIA SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000025 |
| Date of birth | 11 Jun 1986 |
| Plan | GOLD PPO |
| Covered from | 17 Apr 2025 |
| Covered to | 12 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 |
|---|---|---|---|---|---|
| CLM0000107 | 3 Jun 2025 | 613.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 149.31 |
| CLM0000106 | 14 Apr 2025 | 431.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 431.00 |