IVAN SMITH
Dependent on policy B10M000829
Claims
3
Attributed to this person
Charged
1,451.00
Total submitted
Denied
496.89
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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000829 |
| Date of birth | 23 Jan 1958 |
| Plan | PLATINUM PPO |
| Covered from | 5 Aug 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003516 | 18 Oct 2025 | 550.00 | CASCADE CARE | Not denied | — |
| CLM0003517 | 14 Feb 2025 | 755.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 350.89 |
| CLM0003515 | 24 Jul 2024 | 146.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 146.00 |