DAVID SMITH
Dependent on policy B03M000111
Claims
1
Attributed to this person
Charged
813.00
Total submitted
Denied
0.00
0 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 | DAVID SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000111 |
| Date of birth | 19 May 1988 |
| Plan | SILVER HMO |
| Covered from | 2 Apr 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 |
|---|---|---|---|---|---|
| CLM0000440 | 14 Jul 2025 | 813.00 | CASCADE CARE | Not denied | — |