FIONA PATEL
Subscriber on policy B03M000378
Claims
1
Attributed to this person
Charged
107.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
69.55
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 | FIONA PATEL |
| Role on the policy | Subscriber |
| Policy | B03M000378 |
| Date of birth | 19 Mar 1966 |
| Plan | PLATINUM PPO |
| Covered from | 23 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 69.55 |
| Total | 69.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001535 | 8 May 2024 | 107.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |