HENRY PATEL
Dependent on policy B03M000567
Claims
2
Attributed to this person
Charged
1,375.00
Total submitted
Denied
619.00
1 denied claims
Patient responsibility
113.40
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 | HENRY PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000567 |
| Date of birth | 19 Apr 1980 |
| Plan | SILVER HMO |
| Covered from | 9 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 113.40 |
| Total | 113.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002319 | 1 Jul 2026 | 619.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 619.00 |
| CLM0002320 | 13 Feb 2026 | 756.00 | NORTHSTAR MUTUAL | Not denied | — |