KEVIN SMITH
Dependent on policy B02M000126
Claims
3
Attributed to this person
Charged
1,574.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
110.60
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 | KEVIN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000126 |
| Date of birth | 18 Jun 2022 |
| Plan | SILVER HMO |
| Covered from | 23 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 110.60 |
| Total | 110.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000583 | 25 May 2026 | 515.00 | CASCADE CARE | Not denied | — |
| CLM0000582 | 17 Jul 2025 | 553.00 | CASCADE CARE | Not denied | — |
| CLM0000584 | 1 Jun 2025 | 506.00 | CASCADE CARE | Not denied | — |