NADIA REYES
Dependent on policy B07M000215
Claims
3
Attributed to this person
Charged
1,962.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
72.00
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 | NADIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000215 |
| Date of birth | 3 Mar 1976 |
| Plan | BRONZE EPO |
| Covered from | 17 Aug 2024 |
| Covered to | 16 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 72.00 |
| Total | 72.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000897 | 20 Nov 2024 | 782.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000898 | 18 Nov 2024 | 820.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000896 | 19 Sep 2024 | 360.00 | NORTHSTAR MUTUAL | Not denied | — |