YUSUF SMITH
Dependent on policy B03M000602
Claims
3
Attributed to this person
Charged
1,966.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | B03M000602 |
| Date of birth | 18 Apr 2019 |
| Plan | BRONZE EPO |
| Covered from | 29 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002478 | 4 Jul 2026 | 435.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002477 | 23 Jul 2024 | 681.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002476 | 24 Mar 2024 | 850.00 | MERIDIAN HEALTH PLAN | Not denied | — |