YUSUF SMITH
Dependent on policy B02M000723
Claims
2
Attributed to this person
Charged
768.00
Total submitted
Denied
0.00
0 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 | YUSUF SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000723 |
| Date of birth | 7 Nov 1980 |
| Plan | GOLD PPO |
| Covered from | 13 Jan 2024 |
| Covered to | 29 Mar 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003037 | 2 Mar 2024 | 406.00 | CASCADE CARE | Not denied | — |
| CLM0003036 | 28 Jan 2024 | 362.00 | CASCADE CARE | Not denied | — |