ELENA HUGHES
Subscriber on policy B08M000610
Claims
3
Attributed to this person
Charged
1,960.00
Total submitted
Denied
476.00
1 denied claims
Patient responsibility
129.20
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 HUGHES |
| Role on the policy | Subscriber |
| Policy | B08M000610 |
| Date of birth | 27 Oct 1953 |
| Plan | PLATINUM PPO |
| Covered from | 17 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 129.20 |
| Total | 129.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002773 | 26 Jan 2025 | 476.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 476.00 |
| CLM0002772 | 24 Jan 2025 | 838.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002774 | 10 Jul 2024 | 646.00 | NORTHSTAR MUTUAL | Not denied | — |