ELENA SMITH
Subscriber on policy B01M000279
Claims
3
Attributed to this person
Charged
2,351.00
Total submitted
Denied
328.15
1 denied claims
Patient responsibility
176.40
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 | B01M000279 |
| Date of birth | 20 Feb 1963 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 176.40 |
| Total | 176.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001208 | 5 Nov 2025 | 796.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001209 | 27 Jun 2025 | 673.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 328.15 |
| CLM0001210 | 5 Jul 2024 | 882.00 | MERIDIAN HEALTH PLAN | Not denied | — |