ELENA SMITH
Dependent on policy B02M000693
Claims
3
Attributed to this person
Charged
1,883.00
Total submitted
Denied
433.00
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 | ELENA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000693 |
| Date of birth | 2 Dec 2006 |
| 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 |
|---|---|---|---|---|---|
| CLM0002920 | 7 Jun 2025 | 670.00 | CASCADE CARE | Not denied | — |
| CLM0002918 | 11 Dec 2024 | 433.00 | CASCADE CARE | CARC 11 · CODING | 433.00 |
| CLM0002919 | 6 Aug 2024 | 780.00 | CASCADE CARE | Not denied | — |