HENRY ANDERSON
Dependent on policy B03M000864
Claims
3
Attributed to this person
Charged
1,132.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
51.80
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 ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000864 |
| Date of birth | 28 Feb 1998 |
| Plan | SILVER HMO |
| Covered from | 11 Oct 2024 |
| Covered to | 14 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 51.80 |
| Total | 51.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003746 | 25 May 2025 | 125.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003745 | 17 Apr 2025 | 259.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003747 | 25 Feb 2025 | 748.00 | NORTHSTAR MUTUAL | Not denied | — |