KEVIN YAMADA
Subscriber on policy B07M000139
Claims
1
Attributed to this person
Charged
277.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
180.05
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 | KEVIN YAMADA |
| Role on the policy | Subscriber |
| Policy | B07M000139 |
| Date of birth | 3 Mar 1990 |
| Plan | BRONZE EPO |
| Covered from | 26 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 180.05 |
| Total | 180.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000577 | 14 Jul 2025 | 277.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |