TOMAS ANDERSON
Dependent on policy B01M000660
Claims
3
Attributed to this person
Charged
1,320.00
Total submitted
Denied
530.00
2 denied claims
Patient responsibility
0.00
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 | TOMAS ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000660 |
| Date of birth | 13 Apr 2008 |
| Plan | PLATINUM PPO |
| Covered from | 25 Apr 2024 |
| Covered to | 25 Sep 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002961 | 14 Nov 2024 | 389.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 389.00 |
| CLM0002962 | 7 Nov 2024 | 141.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 141.00 |
| CLM0002960 | 17 Sep 2024 | 790.00 | NORTHSTAR MUTUAL | Not denied | — |