LEILA SMITH
Subscriber on policy B04M000148
Claims
2
Attributed to this person
Charged
367.00
Total submitted
Denied
236.19
2 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 | LEILA SMITH |
| Role on the policy | Subscriber |
| Policy | B04M000148 |
| Date of birth | 16 Dec 1971 |
| Plan | BRONZE EPO |
| Covered from | 25 Nov 2024 |
| Covered to | 6 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000680 | 3 May 2025 | 141.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 141.00 |
| CLM0000679 | 5 Apr 2025 | 226.00 | CASCADE CARE | CARC 18 · DUPLICATE | 95.19 |