LEILA IQBAL
Subscriber on policy B09M000693
Claims
2
Attributed to this person
Charged
1,232.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
581.10
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 | LEILA IQBAL |
| Role on the policy | Subscriber |
| Policy | B09M000693 |
| Date of birth | 16 May 1977 |
| Plan | BRONZE EPO |
| Covered from | 16 May 2024 |
| Covered to | 10 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 581.10 |
| Total | 581.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002953 | 23 Jan 2025 | 894.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002952 | 1 Nov 2024 | 338.00 | NORTHSTAR MUTUAL | Not denied | — |