DAVID REYES
Subscriber on policy B01M000523
Claims
2
Attributed to this person
Charged
1,130.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
123.90
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 | DAVID REYES |
| Role on the policy | Subscriber |
| Policy | B01M000523 |
| Date of birth | 25 Apr 1981 |
| Plan | BRONZE EPO |
| Covered from | 23 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 123.90 |
| Total | 123.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002352 | 14 Jul 2026 | 826.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002353 | 18 Apr 2026 | 304.00 | NORTHSTAR MUTUAL | Not denied | — |