AMARA USMAN
Subscriber on policy B01M000851
Claims
3
Attributed to this person
Charged
874.00
Total submitted
Denied
390.00
1 denied claims
Patient responsibility
30.00
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 | AMARA USMAN |
| Role on the policy | Subscriber |
| Policy | B01M000851 |
| Date of birth | 20 Oct 1961 |
| Plan | SILVER HMO |
| Covered from | 29 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003775 | 27 Oct 2025 | 390.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 390.00 |
| CLM0003773 | 20 Dec 2024 | 329.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003774 | 31 May 2024 | 155.00 | NORTHSTAR MUTUAL | Not denied | — |