SOFIA SMITH
Subscriber on policy B03M000723
Claims
1
Attributed to this person
Charged
333.00
Total submitted
Denied
333.00
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 | SOFIA SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000723 |
| Date of birth | 8 Jul 1992 |
| Plan | GOLD PPO |
| Covered from | 4 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003020 | 28 Dec 2025 | 333.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 333.00 |