SOFIA PATEL
Subscriber on policy B10M000517
Claims
1
Attributed to this person
Charged
821.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
164.20
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 | SOFIA PATEL |
| Role on the policy | Subscriber |
| Policy | B10M000517 |
| Date of birth | 30 Jul 1980 |
| Plan | SILVER HMO |
| Covered from | 19 Jun 2024 |
| Covered to | 25 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 164.20 |
| Total | 164.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002126 | 8 Nov 2024 | 821.00 | NORTHSTAR MUTUAL | Not denied | — |