IVAN YAMADA
Subscriber on policy B02M000729
Claims
2
Attributed to this person
Charged
1,676.00
Total submitted
Denied
886.00
1 denied claims
Patient responsibility
118.50
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 | IVAN YAMADA |
| Role on the policy | Subscriber |
| Policy | B02M000729 |
| Date of birth | 15 Dec 1973 |
| Plan | BRONZE EPO |
| Covered from | 20 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 118.50 |
| Total | 118.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003055 | 10 Mar 2026 | 886.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 886.00 |
| CLM0003056 | 21 Apr 2025 | 790.00 | NORTHSTAR MUTUAL | Not denied | — |