BRIAN IQBAL
Dependent on policy B03M000207
Claims
2
Attributed to this person
Charged
1,078.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
148.00
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 IQBAL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000207 |
| Date of birth | 21 Aug 1964 |
| Plan | SILVER HMO |
| Covered from | 27 Jan 2024 |
| Covered to | 23 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 148.00 |
| Total | 148.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000850 | 1 Apr 2024 | 338.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000849 | 9 Jan 2024 | 740.00 | NORTHSTAR MUTUAL | Not denied | — |