VICTOR SMITH
Dependent on policy B04M000548
Claims
1
Attributed to this person
Charged
543.00
Total submitted
Denied
259.47
1 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 | VICTOR SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000548 |
| Date of birth | 23 Apr 2011 |
| Plan | SILVER HMO |
| Covered from | 19 Nov 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 |
|---|---|---|---|---|---|
| CLM0002416 | 27 Jan 2026 | 543.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 259.47 |