SOFIA USMAN
Dependent on policy B09M000047
Claims
2
Attributed to this person
Charged
996.00
Total submitted
Denied
722.95
2 denied claims
Patient responsibility
0.00
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 | SOFIA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000047 |
| Date of birth | 20 Jan 2009 |
| Plan | GOLD PPO |
| Covered from | 4 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000219 | 20 Jun 2026 | 483.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 209.95 |
| CLM0000218 | 5 Dec 2025 | 513.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 513.00 |