FIONA SMITH
Dependent on policy B02M000695
Claims
3
Attributed to this person
Charged
403.00
Total submitted
Denied
264.00
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 | FIONA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000695 |
| Date of birth | 21 Mar 1991 |
| Plan | GOLD PPO |
| Covered from | 2 Mar 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002926 | 5 Aug 2025 | 70.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002928 | 30 May 2025 | 69.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002927 | 16 Feb 2025 | 264.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 264.00 |