TOMAS REYES
Subscriber on policy B09M000440
Claims
1
Attributed to this person
Charged
147.00
Total submitted
Denied
69.27
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 | TOMAS REYES |
| Role on the policy | Subscriber |
| Policy | B09M000440 |
| Date of birth | 20 Sep 1987 |
| Plan | BRONZE EPO |
| Covered from | 24 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001844 | 9 Jun 2026 | 147.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 69.27 |