CARLA FOSTER
Dependent on policy B09M000404
Claims
3
Attributed to this person
Charged
1,600.00
Total submitted
Denied
49.93
1 denied claims
Patient responsibility
122.60
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 | CARLA FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000404 |
| Date of birth | 27 Nov 1963 |
| Plan | BRONZE EPO |
| Covered from | 8 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 122.60 |
| Total | 122.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001679 | 9 May 2026 | 883.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001680 | 27 Oct 2025 | 613.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001678 | 28 Jun 2025 | 104.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 49.93 |