LEILA SMITH
Dependent on policy B01M000865
Claims
3
Attributed to this person
Charged
1,170.00
Total submitted
Denied
917.00
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 | LEILA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000865 |
| Date of birth | 1 Oct 1977 |
| Plan | SILVER HMO |
| Covered from | 9 Apr 2024 |
| Covered to | 13 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 |
|---|---|---|---|---|---|
| CLM0003837 | 11 Nov 2024 | 737.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 737.00 |
| CLM0003838 | 28 Oct 2024 | 180.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 180.00 |
| CLM0003836 | 5 Jun 2024 | 253.00 | CASCADE CARE | Not denied | — |