ZARA ANDERSON
Dependent on policy B07M000294
Claims
3
Attributed to this person
Charged
1,451.00
Total submitted
Denied
549.00
1 denied claims
Patient responsibility
50.00
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 | ZARA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000294 |
| Date of birth | 29 Mar 1961 |
| Plan | BRONZE EPO |
| Covered from | 17 Feb 2024 |
| Covered to | 24 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001277 | 22 Jan 2025 | 549.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 549.00 |
| CLM0001276 | 22 Jun 2024 | 543.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001275 | 30 May 2024 | 359.00 | NORTHSTAR MUTUAL | Not denied | — |