TOMAS IQBAL
Subscriber on policy B03M000323
Claims
1
Attributed to this person
Charged
801.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
520.65
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 IQBAL |
| Role on the policy | Subscriber |
| Policy | B03M000323 |
| Date of birth | 11 Sep 1978 |
| Plan | SILVER HMO |
| Covered from | 27 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 520.65 |
| Total | 520.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001291 | 19 Mar 2025 | 801.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |