FIONA PATEL
Subscriber on policy B09M000761
Claims
3
Attributed to this person
Charged
1,739.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
76.00
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 | FIONA PATEL |
| Role on the policy | Subscriber |
| Policy | B09M000761 |
| Date of birth | 23 Jun 1969 |
| Plan | GOLD PPO |
| Covered from | 24 Apr 2024 |
| Covered to | 1 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 56.00 |
| CARC 3 · Copay | 1 | 20.00 |
| Total | 76.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003216 | 31 Dec 2024 | 280.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003215 | 9 Dec 2024 | 566.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003217 | 29 Mar 2024 | 893.00 | NORTHSTAR MUTUAL | Not denied | — |