JULIA SMITH
Dependent on policy B03M000809
Claims
3
Attributed to this person
Charged
1,249.00
Total submitted
Denied
31.60
1 denied claims
Patient responsibility
66.30
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 | JULIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000809 |
| Date of birth | 26 Mar 1951 |
| 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 | 66.30 |
| Total | 66.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003481 | 14 Jun 2026 | 442.00 | CASCADE CARE | Not denied | — |
| CLM0003483 | 23 Jan 2025 | 88.00 | CASCADE CARE | CARC 18 · DUPLICATE | 31.60 |
| CLM0003482 | 10 Jul 2024 | 719.00 | CASCADE CARE | Not denied | — |