SOFIA REYES
Dependent on policy B09M000267
Claims
3
Attributed to this person
Charged
1,590.00
Total submitted
Denied
838.00
1 denied claims
Patient responsibility
0.00
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 | SOFIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000267 |
| Date of birth | 30 Jun 1983 |
| Plan | GOLD PPO |
| Covered from | 16 Jun 2024 |
| Covered to | 17 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001112 | 9 Dec 2024 | 448.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001111 | 30 Aug 2024 | 304.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001113 | 17 May 2024 | 838.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 838.00 |