ELENA HUGHES
Dependent on policy B09M000194
Claims
2
Attributed to this person
Charged
1,498.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
15.00
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 | ELENA HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000194 |
| Date of birth | 17 Dec 2020 |
| Plan | SILVER HMO |
| Covered from | 21 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000809 | 2 Nov 2024 | 809.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000808 | 13 May 2024 | 689.00 | NORTHSTAR MUTUAL | Not denied | — |