LEILA TANAKA
Dependent on policy B07M000741
Claims
3
Attributed to this person
Charged
825.00
Total submitted
Denied
76.73
1 denied claims
Patient responsibility
30.00
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 | LEILA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000741 |
| Date of birth | 16 Aug 2014 |
| Plan | BRONZE EPO |
| Covered from | 18 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003059 | 15 Jun 2026 | 277.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003060 | 27 Nov 2025 | 318.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 76.73 |
| CLM0003058 | 13 Mar 2025 | 230.00 | NORTHSTAR MUTUAL | Not denied | — |