ZARA REYES
Dependent on policy B07M000557
Claims
3
Attributed to this person
Charged
892.00
Total submitted
Denied
61.00
2 denied claims
Patient responsibility
300.95
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 REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000557 |
| Date of birth | 23 Nov 2018 |
| Plan | GOLD PPO |
| Covered from | 4 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 300.95 |
| Total | 300.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002373 | 29 Mar 2025 | 463.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002372 | 10 Mar 2025 | 368.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002374 | 27 Feb 2025 | 61.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 61.00 |