GRACE FOSTER
Dependent on policy B07M000707
Claims
2
Attributed to this person
Charged
750.00
Total submitted
Denied
545.00
1 denied claims
Patient responsibility
41.00
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 | GRACE FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000707 |
| Date of birth | 20 Jun 1966 |
| Plan | PLATINUM PPO |
| Covered from | 28 Apr 2024 |
| Covered to | 3 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 41.00 |
| Total | 41.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002924 | 23 Sep 2024 | 205.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002925 | 29 Aug 2024 | 545.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 545.00 |