GRACE SMITH
Subscriber on policy B10M000068
Claims
1
Attributed to this person
Charged
881.00
Total submitted
Denied
881.00
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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000068 |
| Date of birth | 19 Sep 2004 |
| Plan | BRONZE EPO |
| Covered from | 6 May 2024 |
| Covered to | 4 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000273 | 12 Dec 2024 | 881.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 881.00 |