JULIA SMITH
Dependent on policy B05M000451
Claims
1
Attributed to this person
Charged
615.00
Total submitted
Denied
615.00
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 19 |
| Policy | B05M000451 |
| Date of birth | 24 Jun 2012 |
| Plan | SILVER HMO |
| Covered from | 13 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 |
|---|---|---|---|---|---|
| CLM0001893 | 15 Jul 2025 | 615.00 | CASCADE CARE | CARC 109 · COB | 615.00 |