WENDY SMITH
Subscriber on policy B01M000263
Claims
2
Attributed to this person
Charged
452.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | WENDY SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000263 |
| Date of birth | 6 Jul 1994 |
| Plan | SILVER HMO |
| Covered from | 11 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001121 | 28 Aug 2026 | 121.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001122 | 31 Jan 2026 | 331.00 | MERIDIAN HEALTH PLAN | Not denied | — |