SOFIA FOSTER
Dependent on policy B08M000684
Claims
3
Attributed to this person
Charged
1,616.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | SOFIA FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000684 |
| Date of birth | 13 Oct 2009 |
| Plan | GOLD PPO |
| Covered from | 5 Mar 2024 |
| Covered to | 6 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003095 | 7 Aug 2024 | 789.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003096 | 25 May 2024 | 566.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003094 | 29 Apr 2024 | 261.00 | NORTHSTAR MUTUAL | Not denied | — |