ELENA SMITH
Dependent on policy B10M000482
Claims
1
Attributed to this person
Charged
140.00
Total submitted
Denied
140.00
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 | ELENA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000482 |
| Date of birth | 28 Aug 1960 |
| Plan | BRONZE EPO |
| Covered from | 22 Oct 2024 |
| Covered to | 11 Feb 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 |
|---|---|---|---|---|---|
| CLM0002005 | 23 Feb 2025 | 140.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 140.00 |