DAVID QUINN
Dependent on policy B02M000489
Claims
1
Attributed to this person
Charged
839.00
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 | DAVID QUINN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000489 |
| Date of birth | 24 Apr 1988 |
| Plan | SILVER HMO |
| Covered from | 22 May 2024 |
| Covered to | open |
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 |
|---|---|---|---|---|---|
| CLM0002081 | 6 Mar 2025 | 839.00 | NORTHSTAR MUTUAL | Not denied | — |