JULIA REYES
Dependent on policy B09M000339
Claims
1
Attributed to this person
Charged
642.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.00
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 | JULIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000339 |
| Date of birth | 18 Jan 1980 |
| Plan | SILVER HMO |
| Covered from | 10 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001397 | 26 Apr 2025 | 642.00 | NORTHSTAR MUTUAL | Not denied | — |