ELENA USMAN
Dependent on policy B08M000128
Claims
2
Attributed to this person
Charged
709.00
Total submitted
Denied
290.00
1 denied claims
Patient responsibility
0.00
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 | ELENA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000128 |
| Date of birth | 25 Aug 1960 |
| Plan | BRONZE EPO |
| Covered from | 19 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000579 | 20 Aug 2026 | 419.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000578 | 14 Jan 2026 | 290.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 290.00 |