TOMAS PATEL
Dependent on policy B07M000409
Claims
2
Attributed to this person
Charged
1,107.00
Total submitted
Denied
1,107.00
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 | TOMAS PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000409 |
| Date of birth | 27 Nov 1996 |
| Plan | SILVER HMO |
| Covered from | 23 Jan 2024 |
| Covered to | 11 May 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001732 | 6 Jun 2024 | 286.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 286.00 |
| CLM0001731 | 1 Jan 2024 | 821.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 821.00 |