RAVI SMITH
Dependent on policy B04M000148
Claims
2
Attributed to this person
Charged
717.00
Total submitted
Denied
465.00
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 | RAVI SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000148 |
| Date of birth | 18 Aug 1964 |
| 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 |
|---|---|---|---|---|---|
| CLM0000682 | 1 Jul 2025 | 252.00 | CASCADE CARE | Not denied | — |
| CLM0000681 | 30 Oct 2024 | 465.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 465.00 |