JULIA SMITH
Dependent on policy B05M000630
Claims
1
Attributed to this person
Charged
774.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.10
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 19 |
| Policy | B05M000630 |
| Date of birth | 16 Jul 1985 |
| Plan | SILVER HMO |
| Covered from | 3 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.10 |
| Total | 116.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002717 | 21 Oct 2025 | 774.00 | MERIDIAN HEALTH PLAN | Not denied | — |