HENRY REYES
Dependent on policy B08M000719
Claims
2
Attributed to this person
Charged
966.00
Total submitted
Denied
666.00
1 denied claims
Patient responsibility
45.00
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 | HENRY REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000719 |
| Date of birth | 10 Mar 1999 |
| Plan | BRONZE EPO |
| Covered from | 3 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 45.00 |
| Total | 45.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003232 | 2 Jan 2026 | 300.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003231 | 30 Sep 2025 | 666.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 666.00 |