CARLA REYES
Dependent on policy B08M000711
Claims
2
Attributed to this person
Charged
851.00
Total submitted
Denied
851.00
2 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 | CARLA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000711 |
| Date of birth | 3 Nov 1994 |
| Plan | BRONZE EPO |
| Covered from | 4 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003197 | 4 Jul 2026 | 129.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 129.00 |
| CLM0003198 | 8 Feb 2024 | 722.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 722.00 |