VICTOR SMITH
Subscriber on policy B10M000633
Claims
2
Attributed to this person
Charged
1,266.00
Total submitted
Denied
636.00
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 | VICTOR SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000633 |
| Date of birth | 19 Mar 1955 |
| Plan | GOLD PPO |
| Covered from | 14 Apr 2025 |
| Covered to | 26 Jun 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 |
|---|---|---|---|---|---|
| CLM0002625 | 21 Jun 2025 | 636.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 636.00 |
| CLM0002624 | 20 Apr 2025 | 630.00 | MERIDIAN HEALTH PLAN | Not denied | — |