ZARA ANDERSON
Dependent on policy B10M000775
Claims
3
Attributed to this person
Charged
940.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | ZARA ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000775 |
| Date of birth | 24 Feb 1982 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2025 |
| Covered to | 18 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003241 | 13 Aug 2025 | 201.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003243 | 18 Jul 2025 | 610.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003242 | 28 Mar 2025 | 129.00 | NORTHSTAR MUTUAL | Not denied | — |