KEVIN KUMAR
Dependent on policy B01M000041
Claims
2
Attributed to this person
Charged
1,059.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
440.70
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 | KEVIN KUMAR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000041 |
| Date of birth | 9 Sep 2018 |
| Plan | GOLD PPO |
| Covered from | 2 Jan 2024 |
| Covered to | 27 Mar 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 440.70 |
| Total | 440.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000164 | 26 Apr 2024 | 678.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000163 | 23 Feb 2024 | 381.00 | NORTHSTAR MUTUAL | Not denied | — |