DAVID ANDERSON
Dependent on policy B06M000512
Claims
2
Attributed to this person
Charged
842.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | DAVID ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000512 |
| Date of birth | 26 Jun 2001 |
| Plan | BRONZE EPO |
| Covered from | 11 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002281 | 28 Jan 2026 | 353.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002280 | 2 May 2025 | 489.00 | NORTHSTAR MUTUAL | Not denied | — |