VICTOR PATEL
Dependent on policy B03M000456
Claims
2
Attributed to this person
Charged
662.00
Total submitted
Denied
229.00
1 denied claims
Patient responsibility
0.00
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 | VICTOR PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000456 |
| Date of birth | 6 Mar 2009 |
| Plan | SILVER HMO |
| Covered from | 11 Jun 2024 |
| Covered to | 19 Sep 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001883 | 18 Jul 2024 | 433.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001882 | 30 Jun 2024 | 229.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 229.00 |