DAVID KUMAR
Dependent on policy B04M000103
Claims
3
Attributed to this person
Charged
1,240.00
Total submitted
Denied
690.00
2 denied claims
Patient responsibility
53.95
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 KUMAR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000103 |
| Date of birth | 21 Sep 2004 |
| Plan | BRONZE EPO |
| Covered from | 26 Nov 2024 |
| Covered to | 7 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 53.95 |
| Total | 53.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000480 | 26 Jul 2025 | 690.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 690.00 |
| CLM0000481 | 26 Jan 2025 | 467.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000479 | 3 Nov 2024 | 83.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |