IVAN SMITH
Subscriber on policy B10M000834
Claims
2
Attributed to this person
Charged
380.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
45.20
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 | IVAN SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000834 |
| Date of birth | 26 Apr 2001 |
| Plan | GOLD PPO |
| Covered from | 7 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 45.20 |
| Total | 45.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003541 | 26 Jun 2026 | 154.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003542 | 12 Sep 2024 | 226.00 | MERIDIAN HEALTH PLAN | Not denied | — |