ZARA FOSTER
Subscriber on policy B03M000375
Claims
3
Attributed to this person
Charged
1,769.00
Total submitted
Denied
599.00
1 denied claims
Patient responsibility
73.80
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 | ZARA FOSTER |
| Role on the policy | Subscriber |
| Policy | B03M000375 |
| Date of birth | 16 Oct 2002 |
| Plan | SILVER HMO |
| Covered from | 14 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 73.80 |
| Total | 73.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001524 | 10 Feb 2025 | 801.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001526 | 23 Sep 2024 | 369.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001525 | 9 Jul 2024 | 599.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 599.00 |