HENRY MURPHY
Dependent on policy B09M000687
Claims
2
Attributed to this person
Charged
379.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
63.80
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 MURPHY |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000687 |
| Date of birth | 18 Apr 1996 |
| Plan | BRONZE EPO |
| Covered from | 12 May 2024 |
| Covered to | 26 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 63.80 |
| Total | 63.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002929 | 27 Sep 2024 | 60.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002930 | 4 Jun 2024 | 319.00 | NORTHSTAR MUTUAL | Not denied | — |