WENDY SMITH
Subscriber on policy B02M000881
Claims
3
Attributed to this person
Charged
1,640.00
Total submitted
Denied
187.26
1 denied claims
Patient responsibility
132.60
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 | WENDY SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000881 |
| Date of birth | 22 Nov 1979 |
| Plan | SILVER HMO |
| Covered from | 7 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 132.60 |
| Total | 132.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003664 | 10 Aug 2026 | 649.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 187.26 |
| CLM0003665 | 16 Apr 2025 | 328.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003666 | 23 Jun 2024 | 663.00 | MERIDIAN HEALTH PLAN | Not denied | — |