BRIAN SMITH
Dependent on policy B05M000762
Claims
3
Attributed to this person
Charged
2,158.00
Total submitted
Denied
970.94
2 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 | BRIAN SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000762 |
| Date of birth | 17 May 1986 |
| Plan | GOLD PPO |
| Covered from | 15 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003270 | 16 Jun 2025 | 732.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003268 | 15 May 2025 | 776.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 776.00 |
| CLM0003269 | 6 Jan 2025 | 650.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 194.94 |