GRACE SMITH
Dependent on policy B06M000016
Claims
1
Attributed to this person
Charged
590.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
118.00
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 | GRACE SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000016 |
| Date of birth | 17 Jul 2017 |
| Plan | PLATINUM PPO |
| Covered from | 15 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 118.00 |
| Total | 118.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000098 | 22 Mar 2026 | 590.00 | MERIDIAN HEALTH PLAN | Not denied | — |