GRACE SMITH
Dependent on policy B10M000227
Claims
2
Attributed to this person
Charged
1,696.00
Total submitted
Denied
334.52
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 | Dependent · relationship 01 |
| Policy | B10M000227 |
| Date of birth | 7 Nov 2002 |
| Plan | GOLD PPO |
| Covered from | 18 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000939 | 31 Jan 2026 | 815.00 | CASCADE CARE | Not denied | — |
| CLM0000938 | 2 Nov 2025 | 881.00 | CASCADE CARE | CARC 11 · CODING | 334.52 |