FIONA SMITH
Subscriber on policy B02M000460
Claims
3
Attributed to this person
Charged
1,449.00
Total submitted
Denied
555.00
1 denied claims
Patient responsibility
92.85
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 | Subscriber |
| Policy | B02M000460 |
| Date of birth | 29 Jan 1978 |
| Plan | PLATINUM PPO |
| Covered from | 9 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 92.85 |
| Total | 92.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001960 | 22 Sep 2025 | 555.00 | CASCADE CARE | CARC 11 · CODING | 555.00 |
| CLM0001961 | 30 Jan 2025 | 619.00 | CASCADE CARE | Not denied | — |
| CLM0001962 | 15 Nov 2024 | 275.00 | CASCADE CARE | Not denied | — |