TOMAS REYES
Dependent on policy B07M000254
Claims
2
Attributed to this person
Charged
984.00
Total submitted
Denied
639.00
1 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 | TOMAS REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000254 |
| Date of birth | 22 Mar 2021 |
| Plan | BRONZE EPO |
| Covered from | 4 May 2025 |
| Covered to | 10 Dec 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 |
|---|---|---|---|---|---|
| CLM0001089 | 30 Dec 2025 | 639.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 639.00 |
| CLM0001088 | 12 May 2025 | 345.00 | NORTHSTAR MUTUAL | Not denied | — |