BRIAN REYES
Subscriber on policy B02M000587
Claims
1
Attributed to this person
Charged
625.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
125.00
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 | BRIAN REYES |
| Role on the policy | Subscriber |
| Policy | B02M000587 |
| Date of birth | 3 Dec 1957 |
| Plan | BRONZE EPO |
| Covered from | 14 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 125.00 |
| Total | 125.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002469 | 27 Mar 2026 | 625.00 | NORTHSTAR MUTUAL | Not denied | — |