NADIA REYES
Subscriber on policy B09M000254
Claims
2
Attributed to this person
Charged
854.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
136.90
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 | NADIA REYES |
| Role on the policy | Subscriber |
| Policy | B09M000254 |
| Date of birth | 13 Nov 1987 |
| Plan | GOLD PPO |
| Covered from | 8 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 101.70 |
| CARC 2 · Coinsurance | 1 | 35.20 |
| Total | 136.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001027 | 2 Oct 2025 | 176.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001026 | 12 Feb 2025 | 678.00 | NORTHSTAR MUTUAL | Not denied | — |