TOMAS YAMADA
Subscriber on policy B06M000859
Claims
2
Attributed to this person
Charged
1,212.00
Total submitted
Denied
342.00
1 denied claims
Patient responsibility
130.50
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 YAMADA |
| Role on the policy | Subscriber |
| Policy | B06M000859 |
| Date of birth | 2 Oct 1967 |
| Plan | GOLD PPO |
| Covered from | 26 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 130.50 |
| Total | 130.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003757 | 5 Nov 2025 | 342.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 342.00 |
| CLM0003756 | 17 Jan 2025 | 870.00 | NORTHSTAR MUTUAL | Not denied | — |