HENRY SMITH
Dependent on policy B01M000637
Claims
1
Attributed to this person
Charged
196.00
Total submitted
Denied
196.00
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 | HENRY SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000637 |
| Date of birth | 30 Oct 1991 |
| Plan | BRONZE EPO |
| Covered from | 20 Sep 2024 |
| Covered to | 10 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002846 | 24 Sep 2024 | 196.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 196.00 |