ELENA SMITH
Subscriber on policy B01M000769
Claims
3
Attributed to this person
Charged
854.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
52.80
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 | ELENA SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000769 |
| Date of birth | 19 May 1995 |
| Plan | BRONZE EPO |
| Covered from | 14 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 52.80 |
| Total | 52.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003419 | 9 Apr 2026 | 412.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003418 | 28 May 2024 | 178.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003417 | 2 Mar 2024 | 264.00 | MERIDIAN HEALTH PLAN | Not denied | — |