BRIAN FOSTER
Dependent on policy B03M000468
Claims
2
Attributed to this person
Charged
475.00
Total submitted
Denied
116.12
2 denied claims
Patient responsibility
72.15
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 | BRIAN FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000468 |
| Date of birth | 26 May 2006 |
| Plan | SILVER HMO |
| Covered from | 1 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 72.15 |
| Total | 72.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001941 | 20 Aug 2025 | 364.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 116.12 |
| CLM0001939 | 20 Jul 2025 | 111.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |