TOMAS ANDERSON
Dependent on policy B08M000726
Claims
3
Attributed to this person
Charged
955.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
71.50
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 | TOMAS ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000726 |
| Date of birth | 7 Oct 1963 |
| Plan | PLATINUM PPO |
| Covered from | 9 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 71.50 |
| Total | 71.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003258 | 3 May 2026 | 110.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003257 | 5 Sep 2025 | 207.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003259 | 22 Feb 2025 | 638.00 | NORTHSTAR MUTUAL | Not denied | — |