OMAR ANDERSON
Subscriber on policy B08M000726
Claims
2
Attributed to this person
Charged
1,034.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | OMAR ANDERSON |
| Role on the policy | Subscriber |
| Policy | B08M000726 |
| Date of birth | 3 Jul 1963 |
| Plan | PLATINUM PPO |
| Covered from | 9 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003256 | 19 Apr 2026 | 694.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003255 | 18 Oct 2024 | 340.00 | NORTHSTAR MUTUAL | Not denied | — |