AMARA SMITH
Dependent on policy B01M000458
Claims
1
Attributed to this person
Charged
462.00
Total submitted
Denied
192.79
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 | AMARA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000458 |
| Date of birth | 4 Feb 1988 |
| Plan | GOLD PPO |
| Covered from | 27 Jan 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 |
|---|---|---|---|---|---|
| CLM0002052 | 28 Sep 2025 | 462.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 192.79 |