TOMAS USMAN
Dependent on policy B01M000580
Claims
2
Attributed to this person
Charged
897.00
Total submitted
Denied
741.40
2 denied claims
Patient responsibility
0.00
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000580 |
| Date of birth | 22 Nov 2005 |
| Plan | SILVER HMO |
| Covered from | 29 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002588 | 17 Jul 2026 | 215.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 59.40 |
| CLM0002589 | 15 Apr 2025 | 682.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 682.00 |