BRIAN FOSTER
Dependent on policy B06M000135
Claims
1
Attributed to this person
Charged
731.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
475.15
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 | BRIAN FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000135 |
| Date of birth | 7 Jul 2017 |
| Plan | SILVER HMO |
| Covered from | 26 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 475.15 |
| Total | 475.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000665 | 30 Oct 2024 | 731.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |