SOFIA SMITH
Dependent on policy B03M000003
Claims
1
Attributed to this person
Charged
716.00
Total submitted
Denied
716.00
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 | Dependent · relationship 19 |
| Policy | B03M000003 |
| Date of birth | 10 Dec 1978 |
| Plan | SILVER HMO |
| Covered from | 16 May 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000019 | 4 Oct 2025 | 716.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 716.00 |