ZARA SMITH
Dependent on policy B03M000098
Claims
3
Attributed to this person
Charged
1,084.00
Total submitted
Denied
575.00
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 | ZARA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000098 |
| Date of birth | 15 Jul 2023 |
| Plan | PLATINUM PPO |
| Covered from | 30 Jul 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 |
|---|---|---|---|---|---|
| CLM0000405 | 16 Apr 2026 | 379.00 | CASCADE CARE | Not denied | — |
| CLM0000407 | 31 Mar 2026 | 130.00 | CASCADE CARE | Not denied | — |
| CLM0000406 | 14 Mar 2026 | 575.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 575.00 |