UMA ANDERSON
Subscriber on policy B09M000061
Claims
3
Attributed to this person
Charged
784.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.20
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 | UMA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B09M000061 |
| Date of birth | 11 Mar 1961 |
| Plan | PLATINUM PPO |
| Covered from | 30 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 36.20 |
| Total | 36.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000276 | 27 Apr 2025 | 181.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000274 | 8 Mar 2025 | 446.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000275 | 27 Feb 2025 | 157.00 | NORTHSTAR MUTUAL | Not denied | — |