TOMAS USMAN
Dependent on policy B08M000457
Claims
3
Attributed to this person
Charged
1,203.00
Total submitted
Denied
570.00
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 | TOMAS USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000457 |
| Date of birth | 28 Oct 1960 |
| Plan | SILVER HMO |
| Covered from | 2 Mar 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 |
|---|---|---|---|---|---|
| CLM0002108 | 10 Oct 2025 | 395.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002106 | 13 May 2025 | 238.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002107 | 22 Apr 2025 | 570.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 570.00 |