CMS-1500 · Box 4

Insured's name.

What goes here

The policyholder name when the patient is not the subscriber. "SAME" when the patient IS the subscriber.

Common mistakes

"Self" checked instead of leaving "SAME" — the two are different and a payer reads them as different intent. Box 4 left blank on a dependent claim, so the payer cannot tie the patient to the policy.