IVAN FOSTER
Subscriber on policy B07M000030
Claims
2
Attributed to this person
Charged
1,336.00
Total submitted
Denied
587.00
1 denied claims
Patient responsibility
112.35
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 | IVAN FOSTER |
| Role on the policy | Subscriber |
| Policy | B07M000030 |
| Date of birth | 28 Jun 1957 |
| Plan | GOLD PPO |
| Covered from | 15 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 112.35 |
| Total | 112.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000136 | 17 Apr 2025 | 587.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 587.00 |
| CLM0000137 | 30 Mar 2025 | 749.00 | NORTHSTAR MUTUAL | Not denied | — |