IVAN REYES
Dependent on policy B06M000470
Claims
3
Attributed to this person
Charged
1,052.00
Total submitted
Denied
444.65
2 denied claims
Patient responsibility
44.40
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 | IVAN REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000470 |
| Date of birth | 15 Jun 1977 |
| Plan | SILVER HMO |
| Covered from | 9 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 44.40 |
| Total | 44.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002120 | 19 Jan 2026 | 430.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 118.65 |
| CLM0002122 | 21 Nov 2025 | 326.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 326.00 |
| CLM0002121 | 20 Oct 2025 | 296.00 | NORTHSTAR MUTUAL | Not denied | — |