ZARA SMITH
Dependent on policy B05M000307
Claims
1
Attributed to this person
Charged
352.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
52.80
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 | ZARA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000307 |
| Date of birth | 9 Oct 1985 |
| Plan | PLATINUM PPO |
| Covered from | 24 Mar 2024 |
| Covered to | 8 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 52.80 |
| Total | 52.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001274 | 15 Mar 2024 | 352.00 | MERIDIAN HEALTH PLAN | Not denied | — |