HENRY HUGHES
Dependent on policy B01M000883
Claims
2
Attributed to this person
Charged
427.00
Total submitted
Denied
212.00
1 denied claims
Patient responsibility
32.25
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 | HENRY HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000883 |
| Date of birth | 17 Jun 1993 |
| Plan | GOLD PPO |
| Covered from | 31 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 32.25 |
| Total | 32.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003915 | 25 Nov 2025 | 212.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 212.00 |
| CLM0003916 | 28 Mar 2025 | 215.00 | NORTHSTAR MUTUAL | Not denied | — |