JULIA SMITH
Subscriber on policy B02M000456
Claims
3
Attributed to this person
Charged
1,182.00
Total submitted
Denied
908.00
3 denied claims
Patient responsibility
178.10
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 | Subscriber |
| Policy | B02M000456 |
| Date of birth | 13 May 2000 |
| Plan | BRONZE EPO |
| Covered from | 7 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 178.10 |
| Total | 178.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001941 | 25 Jan 2026 | 653.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 653.00 |
| CLM0001942 | 19 Sep 2025 | 274.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0001943 | 2 Sep 2024 | 255.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 255.00 |