DAVID REYES
Dependent on policy B09M000572
Claims
1
Attributed to this person
Charged
689.00
Total submitted
Denied
689.00
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 | DAVID REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000572 |
| Date of birth | 12 Mar 1965 |
| Plan | GOLD PPO |
| Covered from | 30 Jun 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 |
|---|---|---|---|---|---|
| CLM0002418 | 6 Jun 2024 | 689.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 689.00 |