HENRY SMITH
Subscriber on policy B10M000282
Claims
3
Attributed to this person
Charged
1,439.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
52.00
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 | HENRY SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000282 |
| Date of birth | 2 Jan 1984 |
| Plan | BRONZE EPO |
| Covered from | 3 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 52.00 |
| Total | 52.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001188 | 8 May 2026 | 80.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0001189 | 8 Jul 2025 | 527.00 | CASCADE CARE | Not denied | — |
| CLM0001187 | 25 May 2025 | 832.00 | CASCADE CARE | Not denied | — |