JULIA SMITH
Dependent on policy B02M000190
Claims
1
Attributed to this person
Charged
609.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
395.85
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 | JULIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000190 |
| Date of birth | 25 Jul 1965 |
| Plan | SILVER HMO |
| Covered from | 16 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 395.85 |
| Total | 395.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000839 | 17 Jun 2026 | 609.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |