VICTOR SMITH
Subscriber on policy B04M000226
Claims
3
Attributed to this person
Charged
1,418.00
Total submitted
Denied
812.00
1 denied claims
Patient responsibility
51.20
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 | VICTOR SMITH |
| Role on the policy | Subscriber |
| Policy | B04M000226 |
| Date of birth | 25 Apr 1986 |
| Plan | PLATINUM PPO |
| Covered from | 6 Mar 2025 |
| Covered to | 19 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 51.20 |
| Total | 51.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000993 | 10 Jul 2025 | 256.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000992 | 14 May 2025 | 350.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000991 | 27 Mar 2025 | 812.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 812.00 |