DAVID ANDERSON
Dependent on policy B06M000591
Claims
2
Attributed to this person
Charged
577.00
Total submitted
Denied
0.00
0 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 | DAVID ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000591 |
| Date of birth | 17 May 2020 |
| Plan | GOLD PPO |
| Covered from | 24 May 2024 |
| Covered to | 17 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002654 | 31 Aug 2024 | 301.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002655 | 25 Aug 2024 | 276.00 | NORTHSTAR MUTUAL | Not denied | — |