ELENA YAMADA
Subscriber on policy B01M000758
Claims
2
Attributed to this person
Charged
1,352.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
95.40
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 | ELENA YAMADA |
| Role on the policy | Subscriber |
| Policy | B01M000758 |
| Date of birth | 7 Nov 1992 |
| Plan | BRONZE EPO |
| Covered from | 24 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 95.40 |
| Total | 95.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003370 | 21 Jul 2026 | 477.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003371 | 29 May 2025 | 875.00 | NORTHSTAR MUTUAL | Not denied | — |