VICTOR SMITH
Dependent on policy B01M000897
Claims
3
Attributed to this person
Charged
1,864.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
104.25
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 | B01M000897 |
| Date of birth | 23 Jul 1994 |
| Plan | BRONZE EPO |
| Covered from | 5 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 104.25 |
| Total | 104.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003973 | 31 Jul 2026 | 389.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003971 | 8 Mar 2026 | 780.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003972 | 19 Feb 2025 | 695.00 | MERIDIAN HEALTH PLAN | Not denied | — |