VICTOR USMAN
Dependent on policy B03M000875
Claims
3
Attributed to this person
Charged
1,965.00
Total submitted
Denied
718.00
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 | VICTOR USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000875 |
| Date of birth | 12 Jun 1987 |
| Plan | BRONZE EPO |
| Covered from | 11 Oct 2024 |
| Covered to | 2 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003798 | 4 Jan 2025 | 718.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 718.00 |
| CLM0003800 | 16 Dec 2024 | 659.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003799 | 14 Nov 2024 | 588.00 | NORTHSTAR MUTUAL | Not denied | — |