VICTOR REYES
Subscriber on policy B02M000444
Claims
2
Attributed to this person
Charged
1,397.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
431.60
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 | VICTOR REYES |
| Role on the policy | Subscriber |
| Policy | B02M000444 |
| Date of birth | 14 May 1996 |
| Plan | GOLD PPO |
| Covered from | 24 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 431.60 |
| Total | 431.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001889 | 19 Dec 2025 | 664.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001888 | 6 Feb 2025 | 733.00 | NORTHSTAR MUTUAL | Not denied | — |