OMAR REYES
Dependent on policy B06M000831
Claims
3
Attributed to this person
Charged
1,723.00
Total submitted
Denied
617.00
1 denied claims
Patient responsibility
103.80
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 | OMAR REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000831 |
| Date of birth | 27 Jun 1991 |
| Plan | BRONZE EPO |
| Covered from | 2 Sep 2024 |
| Covered to | 28 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 103.80 |
| Total | 103.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003632 | 8 Mar 2025 | 617.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 617.00 |
| CLM0003633 | 12 Sep 2024 | 414.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003631 | 21 Aug 2024 | 692.00 | NORTHSTAR MUTUAL | Not denied | — |