HENRY ANDERSON
Subscriber on policy B08M000244
Claims
3
Attributed to this person
Charged
1,410.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
69.30
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 | B08M000244 |
| Date of birth | 12 Jul 2000 |
| Plan | BRONZE EPO |
| Covered from | 3 Apr 2025 |
| Covered to | 11 Jan 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 69.30 |
| Total | 69.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001104 | 24 Nov 2025 | 721.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001103 | 16 Oct 2025 | 227.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001102 | 21 Jul 2025 | 462.00 | NORTHSTAR MUTUAL | Not denied | — |