LEILA SMITH
Subscriber on policy B01M000683
Claims
2
Attributed to this person
Charged
403.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.00
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 | LEILA SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000683 |
| Date of birth | 7 Mar 1996 |
| Plan | GOLD PPO |
| Covered from | 19 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 36.00 |
| Total | 36.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003061 | 4 Aug 2024 | 163.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003060 | 20 Feb 2024 | 240.00 | MERIDIAN HEALTH PLAN | Not denied | — |