HENRY REYES
Dependent on policy B06M000336
Claims
2
Attributed to this person
Charged
913.00
Total submitted
Denied
773.00
1 denied claims
Patient responsibility
40.00
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 | HENRY REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000336 |
| Date of birth | 6 Jan 1973 |
| Plan | SILVER HMO |
| Covered from | 8 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001518 | 19 Feb 2026 | 773.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 773.00 |
| CLM0001517 | 20 Feb 2025 | 140.00 | NORTHSTAR MUTUAL | Not denied | — |