AMARA REYES
Subscriber on policy B01M000645
Claims
3
Attributed to this person
Charged
1,461.00
Total submitted
Denied
1,244.00
2 denied claims
Patient responsibility
50.00
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 | AMARA REYES |
| Role on the policy | Subscriber |
| Policy | B01M000645 |
| Date of birth | 6 May 1971 |
| Plan | PLATINUM PPO |
| Covered from | 9 Nov 2024 |
| Covered to | 6 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002873 | 20 Apr 2025 | 217.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002875 | 1 Feb 2025 | 846.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 846.00 |
| CLM0002874 | 14 Oct 2024 | 398.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 398.00 |