IVAN PATEL
Dependent on policy B03M000456
Claims
3
Attributed to this person
Charged
1,418.00
Total submitted
Denied
674.00
1 denied claims
Patient responsibility
111.60
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 | IVAN PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000456 |
| Date of birth | 24 Apr 1998 |
| Plan | SILVER HMO |
| Covered from | 11 Jun 2024 |
| Covered to | 19 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 2 | 111.60 |
| Total | 111.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001886 | 1 Oct 2024 | 662.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001885 | 24 Aug 2024 | 82.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001887 | 13 May 2024 | 674.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 674.00 |