HENRY ANDERSON
Dependent on policy B10M000111
Claims
3
Attributed to this person
Charged
1,005.00
Total submitted
Denied
882.00
2 denied claims
Patient responsibility
24.60
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000111 |
| Date of birth | 2 Mar 1965 |
| Plan | PLATINUM PPO |
| Covered from | 29 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 24.60 |
| Total | 24.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000454 | 27 Nov 2025 | 636.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 636.00 |
| CLM0000455 | 16 Jul 2025 | 246.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 246.00 |
| CLM0000453 | 31 May 2025 | 123.00 | NORTHSTAR MUTUAL | Not denied | — |