PRIYA SMITH
Subscriber on policy B02M000484
Claims
3
Attributed to this person
Charged
922.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
105.40
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 | PRIYA SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000484 |
| Date of birth | 20 Mar 1982 |
| Plan | GOLD PPO |
| Covered from | 8 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 105.40 |
| Total | 105.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002060 | 9 Mar 2025 | 527.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002059 | 3 Feb 2025 | 155.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002058 | 30 Oct 2024 | 240.00 | MERIDIAN HEALTH PLAN | Not denied | — |