DAVID ANDERSON
Dependent on policy B01M000660
Claims
3
Attributed to this person
Charged
1,656.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
590.45
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 01 |
| Policy | B01M000660 |
| Date of birth | 12 Apr 2003 |
| Plan | PLATINUM PPO |
| Covered from | 25 Apr 2024 |
| Covered to | 25 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 579.80 |
| CARC 1 · Deductible | 1 | 10.65 |
| Total | 590.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002958 | 10 Nov 2024 | 892.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002957 | 27 Aug 2024 | 693.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002959 | 9 Jun 2024 | 71.00 | NORTHSTAR MUTUAL | Not denied | — |