DAVID REYES
Dependent on policy B07M000215
Claims
2
Attributed to this person
Charged
1,026.00
Total submitted
Denied
1,026.00
2 denied claims
Patient responsibility
0.00
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 | DAVID REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000215 |
| Date of birth | 13 Dec 2010 |
| Plan | BRONZE EPO |
| Covered from | 17 Aug 2024 |
| Covered to | 16 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000902 | 29 Apr 2025 | 553.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 553.00 |
| CLM0000901 | 17 Apr 2025 | 473.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 473.00 |