HENRY ANDERSON
Dependent on policy B06M000690
Claims
3
Attributed to this person
Charged
1,755.00
Total submitted
Denied
325.42
2 denied claims
Patient responsibility
102.00
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 | HENRY ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000690 |
| Date of birth | 6 Jun 2002 |
| Plan | GOLD PPO |
| Covered from | 1 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 102.00 |
| Total | 102.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003084 | 20 Jan 2026 | 593.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 131.15 |
| CLM0003086 | 18 Jun 2025 | 482.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 194.27 |
| CLM0003085 | 24 May 2025 | 680.00 | NORTHSTAR MUTUAL | Not denied | — |