YUSUF SMITH
Dependent on policy B02M000693
Claims
2
Attributed to this person
Charged
1,080.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
145.60
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 | YUSUF SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000693 |
| Date of birth | 10 Aug 1997 |
| Plan | GOLD PPO |
| Covered from | 30 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 145.60 |
| Total | 145.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002915 | 20 Apr 2026 | 728.00 | CASCADE CARE | Not denied | — |
| CLM0002914 | 13 Dec 2025 | 352.00 | CASCADE CARE | Not denied | — |