FIONA SMITH
Dependent on policy B02M000863
Claims
3
Attributed to this person
Charged
1,681.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
309.40
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 | FIONA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000863 |
| Date of birth | 22 May 2011 |
| Plan | BRONZE EPO |
| Covered from | 27 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 309.40 |
| Total | 309.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003601 | 17 Nov 2025 | 476.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003599 | 20 Jul 2025 | 401.00 | CASCADE CARE | Not denied | — |
| CLM0003600 | 7 Jun 2025 | 804.00 | CASCADE CARE | Not denied | — |