OMAR USMAN
Subscriber on policy B10M000346
Claims
2
Attributed to this person
Charged
427.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
45.45
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 | OMAR USMAN |
| Role on the policy | Subscriber |
| Policy | B10M000346 |
| Date of birth | 1 Dec 1991 |
| Plan | BRONZE EPO |
| Covered from | 5 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 45.45 |
| Total | 45.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001445 | 30 Jul 2024 | 303.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001446 | 6 Jul 2024 | 124.00 | NORTHSTAR MUTUAL | Not denied | — |