JULIA REYES
Subscriber on policy B09M000267
Claims
3
Attributed to this person
Charged
1,197.00
Total submitted
Denied
64.68
1 denied claims
Patient responsibility
67.20
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 | JULIA REYES |
| Role on the policy | Subscriber |
| Policy | B09M000267 |
| Date of birth | 30 Sep 1974 |
| Plan | GOLD PPO |
| Covered from | 16 Jun 2024 |
| Covered to | 17 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 67.20 |
| Total | 67.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001108 | 9 Feb 2025 | 645.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001110 | 26 Jun 2024 | 216.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 64.68 |
| CLM0001109 | 14 Jun 2024 | 336.00 | NORTHSTAR MUTUAL | Not denied | — |