HENRY ANDERSON
Subscriber on policy B10M000793
Claims
2
Attributed to this person
Charged
1,151.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
15.00
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 | HENRY ANDERSON |
| Role on the policy | Subscriber |
| Policy | B10M000793 |
| Date of birth | 13 Mar 1972 |
| Plan | PLATINUM PPO |
| Covered from | 23 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003349 | 7 Mar 2026 | 470.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003348 | 10 Sep 2025 | 681.00 | NORTHSTAR MUTUAL | Not denied | — |