HENRY PATEL
Dependent on policy B10M000157
Claims
2
Attributed to this person
Charged
1,420.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
160.80
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 PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000157 |
| Date of birth | 17 Jan 1986 |
| Plan | BRONZE EPO |
| Covered from | 30 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 160.80 |
| Total | 160.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000637 | 23 Jan 2026 | 804.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000636 | 30 Apr 2025 | 616.00 | NORTHSTAR MUTUAL | Not denied | — |