JULIA REYES
Subscriber on policy B03M000624
Claims
3
Attributed to this person
Charged
1,369.00
Total submitted
Denied
120.58
1 denied claims
Patient responsibility
44.20
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 | JULIA REYES |
| Role on the policy | Subscriber |
| Policy | B03M000624 |
| Date of birth | 17 Jun 1963 |
| Plan | SILVER HMO |
| Covered from | 17 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 44.20 |
| Total | 44.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002577 | 20 Jun 2026 | 290.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 120.58 |
| CLM0002576 | 4 Mar 2026 | 858.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002575 | 24 Nov 2025 | 221.00 | NORTHSTAR MUTUAL | Not denied | — |