SOFIA PATEL
Dependent on policy B09M000517
Claims
2
Attributed to this person
Charged
864.00
Total submitted
Denied
349.56
2 denied claims
Patient responsibility
39.00
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 PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000517 |
| Date of birth | 22 Apr 2018 |
| Plan | PLATINUM PPO |
| Covered from | 8 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 39.00 |
| Total | 39.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002192 | 1 Jul 2025 | 804.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 349.56 |
| CLM0002193 | 9 Oct 2024 | 60.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |