VICTOR USMAN
Dependent on policy B04M000070
Claims
3
Attributed to this person
Charged
1,307.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
66.40
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 | VICTOR USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000070 |
| Date of birth | 23 Mar 1984 |
| Plan | SILVER HMO |
| Covered from | 23 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 66.40 |
| Total | 66.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000326 | 30 Jun 2026 | 617.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000325 | 26 Aug 2024 | 332.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000324 | 23 Jul 2024 | 358.00 | NORTHSTAR MUTUAL | Not denied | — |