IVAN SMITH
Dependent on policy B02M000715
Claims
2
Attributed to this person
Charged
945.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
114.45
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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000715 |
| Date of birth | 15 Dec 2013 |
| Plan | GOLD PPO |
| Covered from | 2 Apr 2025 |
| Covered to | 17 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 114.45 |
| Total | 114.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003005 | 15 Oct 2025 | 763.00 | CASCADE CARE | Not denied | — |
| CLM0003006 | 20 Apr 2025 | 182.00 | CASCADE CARE | Not denied | — |