HENRY PATEL
Subscriber on policy B09M000053
Claims
2
Attributed to this person
Charged
1,066.00
Total submitted
Denied
623.00
1 denied claims
Patient responsibility
66.45
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 | HENRY PATEL |
| Role on the policy | Subscriber |
| Policy | B09M000053 |
| Date of birth | 9 Dec 1962 |
| Plan | PLATINUM PPO |
| Covered from | 28 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 66.45 |
| Total | 66.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000247 | 30 Aug 2025 | 443.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000246 | 15 May 2025 | 623.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 623.00 |