OMAR SMITH
Subscriber on policy B02M000420
Claims
2
Attributed to this person
Charged
1,340.00
Total submitted
Denied
185.72
1 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 | OMAR SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000420 |
| Date of birth | 13 Apr 1987 |
| Plan | GOLD PPO |
| Covered from | 4 Dec 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 |
|---|---|---|---|---|---|
| CLM0001795 | 25 Dec 2025 | 513.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001794 | 10 Oct 2025 | 827.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 185.72 |