VICTOR QUINN
Subscriber on policy B09M000058
Claims
1
Attributed to this person
Charged
252.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
163.80
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 | VICTOR QUINN |
| Role on the policy | Subscriber |
| Policy | B09M000058 |
| Date of birth | 9 Dec 1988 |
| Plan | BRONZE EPO |
| Covered from | 17 Mar 2024 |
| Covered to | 2 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 163.80 |
| Total | 163.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000265 | 30 Jun 2024 | 252.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |