CARLA ANDERSON
Dependent on policy B10M000272
Claims
2
Attributed to this person
Charged
827.00
Total submitted
Denied
592.00
1 denied claims
Patient responsibility
47.00
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 | CARLA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000272 |
| Date of birth | 6 May 1956 |
| Plan | GOLD PPO |
| Covered from | 23 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 47.00 |
| Total | 47.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001133 | 28 May 2026 | 592.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 592.00 |
| CLM0001134 | 12 Jul 2024 | 235.00 | NORTHSTAR MUTUAL | Not denied | — |