HENRY SMITH
Dependent on policy B09M000590
Claims
3
Attributed to this person
Charged
989.00
Total submitted
Denied
95.51
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 | HENRY SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000590 |
| Date of birth | 3 May 2017 |
| Plan | PLATINUM PPO |
| Covered from | 2 Oct 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 |
|---|---|---|---|---|---|
| CLM0002506 | 25 Mar 2026 | 215.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 95.51 |
| CLM0002507 | 30 Jun 2025 | 470.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002508 | 8 Mar 2025 | 304.00 | NORTHSTAR MUTUAL | Not denied | — |