SOFIA SMITH
Dependent on policy B02M000693
Claims
2
Attributed to this person
Charged
551.00
Total submitted
Denied
39.19
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 | SOFIA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000693 |
| Date of birth | 4 Jun 2022 |
| Plan | GOLD PPO |
| Covered from | 30 Jul 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002917 | 15 Jan 2026 | 145.00 | CASCADE CARE | CARC 96 · NON_COVERED | 39.19 |
| CLM0002916 | 30 Aug 2024 | 406.00 | CASCADE CARE | Not denied | — |