PRIYA IQBAL
Dependent on policy B01M000694
Claims
3
Attributed to this person
Charged
1,067.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
96.20
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 | PRIYA IQBAL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000694 |
| Date of birth | 22 Apr 2005 |
| Plan | PLATINUM PPO |
| Covered from | 4 Nov 2024 |
| Covered to | 11 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 96.20 |
| Total | 96.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003114 | 5 May 2025 | 262.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003112 | 22 Mar 2025 | 657.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003113 | 6 Mar 2025 | 148.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |