ELENA SMITH
Subscriber on policy B10M000473
Claims
3
Attributed to this person
Charged
960.00
Total submitted
Denied
732.00
2 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 | ELENA SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000473 |
| Date of birth | 18 Feb 1955 |
| Plan | GOLD PPO |
| Covered from | 6 Jan 2025 |
| Covered to | 27 Mar 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 |
|---|---|---|---|---|---|
| CLM0001963 | 28 Apr 2025 | 228.00 | CASCADE CARE | Not denied | — |
| CLM0001964 | 18 Apr 2025 | 300.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 300.00 |
| CLM0001965 | 10 Dec 2024 | 432.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 432.00 |