IVAN TANAKA
Dependent on policy B10M000284
Claims
3
Attributed to this person
Charged
1,322.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
39.30
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 | IVAN TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000284 |
| Date of birth | 25 Aug 2014 |
| Plan | BRONZE EPO |
| Covered from | 20 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 39.30 |
| Total | 39.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001199 | 4 Jan 2026 | 767.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001200 | 13 Nov 2024 | 293.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001201 | 5 Sep 2024 | 262.00 | NORTHSTAR MUTUAL | Not denied | — |