WENDY SMITH
Subscriber on policy B02M000877
Claims
2
Attributed to this person
Charged
775.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
10.80
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 | B02M000877 |
| Date of birth | 23 Feb 1999 |
| Plan | GOLD PPO |
| Covered from | 2 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 10.80 |
| Total | 10.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003655 | 7 Aug 2026 | 703.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003654 | 6 Oct 2025 | 72.00 | NORTHSTAR MUTUAL | Not denied | — |