SOFIA QUINN
Dependent on policy B03M000884
Claims
3
Attributed to this person
Charged
1,668.00
Total submitted
Denied
1,036.00
2 denied claims
Patient responsibility
126.40
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 | SOFIA QUINN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000884 |
| Date of birth | 11 Mar 2013 |
| Plan | PLATINUM PPO |
| Covered from | 11 Feb 2025 |
| Covered to | 11 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 126.40 |
| Total | 126.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003827 | 2 Aug 2025 | 320.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 320.00 |
| CLM0003825 | 17 Feb 2025 | 632.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003826 | 9 Feb 2025 | 716.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 716.00 |