OMAR SMITH
Dependent on policy B01M000602
Claims
1
Attributed to this person
Charged
288.00
Total submitted
Denied
288.00
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 | OMAR SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000602 |
| Date of birth | 13 Aug 1979 |
| Plan | GOLD PPO |
| Covered from | 28 Feb 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 |
|---|---|---|---|---|---|
| CLM0002679 | 23 Feb 2025 | 288.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 288.00 |