ELENA REYES
Dependent on policy B03M000634
Claims
1
Attributed to this person
Charged
157.00
Total submitted
Denied
157.00
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 | ELENA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000634 |
| Date of birth | 5 Jun 2015 |
| Plan | GOLD PPO |
| Covered from | 24 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002617 | 1 Jun 2025 | 157.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 157.00 |