VICTOR SMITH
Subscriber on policy B10M000095
Claims
3
Attributed to this person
Charged
1,481.00
Total submitted
Denied
254.00
1 denied claims
Patient responsibility
91.20
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 | VICTOR SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000095 |
| Date of birth | 21 Jun 1963 |
| Plan | PLATINUM PPO |
| Covered from | 12 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 91.20 |
| Total | 91.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000395 | 17 Jul 2026 | 619.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000396 | 12 Feb 2026 | 608.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000397 | 18 Jun 2025 | 254.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 254.00 |