WENDY PATEL
Subscriber on policy B04M000102
Claims
3
Attributed to this person
Charged
2,095.00
Total submitted
Denied
817.00
1 denied claims
Patient responsibility
167.00
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 | WENDY PATEL |
| Role on the policy | Subscriber |
| Policy | B04M000102 |
| Date of birth | 5 Sep 1994 |
| Plan | SILVER HMO |
| Covered from | 21 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 167.00 |
| Total | 167.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000472 | 24 Mar 2026 | 443.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000471 | 26 Aug 2025 | 835.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000473 | 23 May 2025 | 817.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 817.00 |