OMAR REYES
Subscriber on policy B08M000686
Claims
3
Attributed to this person
Charged
1,651.00
Total submitted
Denied
862.00
1 denied claims
Patient responsibility
104.60
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 | OMAR REYES |
| Role on the policy | Subscriber |
| Policy | B08M000686 |
| Date of birth | 6 Jan 1995 |
| Plan | BRONZE EPO |
| Covered from | 8 Jun 2025 |
| Covered to | 24 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 104.60 |
| Total | 104.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003101 | 11 Sep 2025 | 523.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003099 | 18 Jul 2025 | 266.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003100 | 23 May 2025 | 862.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 862.00 |