TOMAS USMAN
Subscriber on policy B09M000047
Claims
2
Attributed to this person
Charged
1,013.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.00
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 | TOMAS USMAN |
| Role on the policy | Subscriber |
| Policy | B09M000047 |
| Date of birth | 10 Jun 1993 |
| Plan | GOLD PPO |
| Covered from | 4 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000214 | 30 Jun 2026 | 889.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000215 | 15 Mar 2026 | 124.00 | NORTHSTAR MUTUAL | Not denied | — |