IVAN YAMADA
Dependent on policy B08M000269
Claims
3
Attributed to this person
Charged
1,356.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
290.55
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 | IVAN YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000269 |
| Date of birth | 22 Jul 2009 |
| Plan | PLATINUM PPO |
| Covered from | 10 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 290.55 |
| Total | 290.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001229 | 9 Dec 2025 | 365.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001228 | 13 Nov 2025 | 447.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001230 | 28 Mar 2025 | 544.00 | NORTHSTAR MUTUAL | Not denied | — |