LEILA TANAKA
Dependent on policy B04M000116
Claims
2
Attributed to this person
Charged
1,423.00
Total submitted
Denied
1,423.00
2 denied claims
Patient responsibility
0.00
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 | LEILA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000116 |
| Date of birth | 29 Sep 2018 |
| Plan | GOLD PPO |
| Covered from | 19 Apr 2025 |
| Covered to | 27 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000542 | 16 Sep 2025 | 560.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 560.00 |
| CLM0000543 | 31 Jul 2025 | 863.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 863.00 |