WENDY REYES
Dependent on policy B01M000575
Claims
2
Attributed to this person
Charged
548.00
Total submitted
Denied
61.00
1 denied claims
Patient responsibility
97.40
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 | WENDY REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000575 |
| Date of birth | 5 Sep 2007 |
| Plan | BRONZE EPO |
| Covered from | 24 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 97.40 |
| Total | 97.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002564 | 24 Oct 2025 | 61.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 61.00 |
| CLM0002565 | 27 Jun 2025 | 487.00 | NORTHSTAR MUTUAL | Not denied | — |