LEILA SMITH
Subscriber on policy B02M000347
Claims
2
Attributed to this person
Charged
1,118.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
238.55
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 | LEILA SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000347 |
| Date of birth | 25 Jun 1951 |
| Plan | SILVER HMO |
| Covered from | 4 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 238.55 |
| Total | 238.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001482 | 15 Feb 2026 | 367.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001483 | 25 Oct 2024 | 751.00 | NORTHSTAR MUTUAL | Not denied | — |