DAVID PATEL
Subscriber on policy B03M000878
Claims
3
Attributed to this person
Charged
1,597.00
Total submitted
Denied
1,263.00
2 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 | DAVID PATEL |
| Role on the policy | Subscriber |
| Policy | B03M000878 |
| Date of birth | 30 May 1977 |
| Plan | GOLD PPO |
| Covered from | 25 Feb 2024 |
| Covered to | 12 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003808 | 6 Jul 2024 | 334.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003807 | 29 May 2024 | 453.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 453.00 |
| CLM0003806 | 21 May 2024 | 810.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 810.00 |