JULIA SMITH
Dependent on policy B05M000307
Claims
1
Attributed to this person
Charged
128.00
Total submitted
Denied
128.00
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 | JULIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000307 |
| Date of birth | 4 Feb 1965 |
| Plan | PLATINUM PPO |
| Covered from | 24 Mar 2024 |
| Covered to | 8 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001273 | 7 Sep 2024 | 128.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 128.00 |