PRIYA SMITH
Subscriber on policy B03M000809
Claims
3
Attributed to this person
Charged
1,307.00
Total submitted
Denied
533.00
1 denied claims
Patient responsibility
45.90
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 | PRIYA SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000809 |
| Date of birth | 17 Dec 1953 |
| Plan | PLATINUM PPO |
| Covered from | 13 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 45.90 |
| Total | 45.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003479 | 19 Sep 2025 | 468.00 | CASCADE CARE | Not denied | — |
| CLM0003480 | 22 Oct 2024 | 306.00 | CASCADE CARE | Not denied | — |
| CLM0003478 | 16 May 2024 | 533.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 533.00 |