HENRY ANDERSON
Subscriber on policy B08M000068
Claims
3
Attributed to this person
Charged
1,642.00
Total submitted
Denied
478.18
3 denied claims
Patient responsibility
421.85
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 ANDERSON |
| Role on the policy | Subscriber |
| Policy | B08M000068 |
| Date of birth | 10 Mar 1988 |
| Plan | PLATINUM PPO |
| Covered from | 22 May 2025 |
| Covered to | 11 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 421.85 |
| Total | 421.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000308 | 8 Jan 2026 | 332.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 332.00 |
| CLM0000307 | 7 Nov 2025 | 649.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000309 | 10 Jul 2025 | 661.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 146.18 |