LEILA HUGHES
Dependent on policy B01M000667
Claims
3
Attributed to this person
Charged
1,186.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.20
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 | LEILA HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000667 |
| Date of birth | 22 Feb 1970 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 2025 |
| Covered to | 30 Jan 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 40.20 |
| Total | 40.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002992 | 11 Jan 2026 | 232.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002994 | 27 Nov 2025 | 201.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002993 | 29 Aug 2025 | 753.00 | NORTHSTAR MUTUAL | Not denied | — |