DAVID REYES
Subscriber on policy B03M000882
Claims
3
Attributed to this person
Charged
960.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 REYES |
| Role on the policy | Subscriber |
| Policy | B03M000882 |
| Date of birth | 2 Jan 1974 |
| Plan | BRONZE EPO |
| Covered from | 22 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003815 | 15 Apr 2026 | 185.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003816 | 25 Dec 2025 | 125.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003817 | 22 Dec 2024 | 650.00 | NORTHSTAR MUTUAL | Not denied | — |