ELENA QUINN
Subscriber on policy B08M000783
Claims
3
Attributed to this person
Charged
1,083.00
Total submitted
Denied
37.91
1 denied claims
Patient responsibility
164.40
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 | ELENA QUINN |
| Role on the policy | Subscriber |
| Policy | B08M000783 |
| Date of birth | 15 Jul 1985 |
| Plan | PLATINUM PPO |
| Covered from | 15 Sep 2024 |
| Covered to | 16 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 164.40 |
| Total | 164.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003501 | 9 Mar 2025 | 168.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 37.91 |
| CLM0003500 | 12 Dec 2024 | 822.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003499 | 27 Sep 2024 | 93.00 | NORTHSTAR MUTUAL | Not denied | — |