FIONA ANDERSON
Subscriber on policy B07M000402
Claims
3
Attributed to this person
Charged
1,582.00
Total submitted
Denied
696.00
2 denied claims
Patient responsibility
401.70
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 | FIONA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B07M000402 |
| Date of birth | 15 Dec 1979 |
| Plan | GOLD PPO |
| Covered from | 10 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 401.70 |
| Total | 401.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001712 | 19 Apr 2026 | 696.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 696.00 |
| CLM0001711 | 27 Mar 2026 | 268.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001710 | 25 Nov 2025 | 618.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |