OMAR HUGHES
Subscriber on policy B02M000538
Claims
3
Attributed to this person
Charged
1,387.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
140.40
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 | OMAR HUGHES |
| Role on the policy | Subscriber |
| Policy | B02M000538 |
| Date of birth | 1 Aug 1969 |
| Plan | GOLD PPO |
| Covered from | 7 Oct 2024 |
| Covered to | 2 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 140.40 |
| Total | 140.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002270 | 13 Feb 2025 | 588.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002271 | 2 Oct 2024 | 97.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002269 | 21 Sep 2024 | 702.00 | NORTHSTAR MUTUAL | Not denied | — |