CARLA FOSTER
Dependent on policy B09M000051
Claims
3
Attributed to this person
Charged
1,045.00
Total submitted
Denied
252.00
1 denied claims
Patient responsibility
81.30
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 | CARLA FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000051 |
| Date of birth | 31 Jan 2015 |
| Plan | BRONZE EPO |
| Covered from | 12 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 81.30 |
| Total | 81.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000236 | 2 Apr 2025 | 252.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 252.00 |
| CLM0000238 | 5 Mar 2025 | 542.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000237 | 30 Nov 2024 | 251.00 | NORTHSTAR MUTUAL | Not denied | — |