DAVID SMITH
Dependent on policy B04M000814
Claims
3
Attributed to this person
Charged
1,240.00
Total submitted
Denied
256.00
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 | DAVID SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000814 |
| Date of birth | 28 Nov 1990 |
| Plan | SILVER HMO |
| Covered from | 14 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003546 | 4 Jun 2026 | 256.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 256.00 |
| CLM0003544 | 11 May 2026 | 444.00 | CASCADE CARE | Not denied | — |
| CLM0003545 | 24 Jun 2025 | 540.00 | CASCADE CARE | Not denied | — |