HENRY QUINN
Dependent on policy B06M000395
Claims
2
Attributed to this person
Charged
1,104.00
Total submitted
Denied
370.00
1 denied claims
Patient responsibility
146.80
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 QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000395 |
| Date of birth | 1 Sep 1960 |
| Plan | PLATINUM PPO |
| Covered from | 12 Jul 2024 |
| Covered to | 6 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 146.80 |
| Total | 146.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001796 | 9 Jul 2024 | 370.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 370.00 |
| CLM0001797 | 26 Jun 2024 | 734.00 | NORTHSTAR MUTUAL | Not denied | — |