AMARA PATEL
Dependent on policy B07M000621
Claims
2
Attributed to this person
Charged
685.00
Total submitted
Denied
0.00
0 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 | AMARA PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000621 |
| Date of birth | 27 Jan 1974 |
| Plan | BRONZE EPO |
| Covered from | 5 Jun 2024 |
| Covered to | open |
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 |
|---|---|---|---|---|---|
| CLM0002615 | 24 Mar 2025 | 219.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002614 | 21 Jan 2025 | 466.00 | NORTHSTAR MUTUAL | Not denied | — |