VICTOR KUMAR
Subscriber on policy B10M000205
Claims
2
Attributed to this person
Charged
590.00
Total submitted
Denied
52.32
1 denied claims
Patient responsibility
61.20
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 | VICTOR KUMAR |
| Role on the policy | Subscriber |
| Policy | B10M000205 |
| Date of birth | 12 Apr 1976 |
| Plan | SILVER HMO |
| Covered from | 2 Jul 2024 |
| Covered to | 15 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 61.20 |
| Total | 61.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000842 | 15 Sep 2024 | 182.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 52.32 |
| CLM0000843 | 28 Jul 2024 | 408.00 | NORTHSTAR MUTUAL | Not denied | — |