TOMAS HUGHES
Subscriber on policy B02M000491
Claims
1
Attributed to this person
Charged
263.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
170.95
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 | TOMAS HUGHES |
| Role on the policy | Subscriber |
| Policy | B02M000491 |
| Date of birth | 1 Jun 1968 |
| Plan | GOLD PPO |
| Covered from | 20 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 170.95 |
| Total | 170.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002093 | 6 Jun 2025 | 263.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |