TOMAS MURPHY
Dependent on policy B04M000174
Claims
1
Attributed to this person
Charged
692.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
103.80
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 | TOMAS MURPHY |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000174 |
| Date of birth | 17 Oct 2006 |
| Plan | BRONZE EPO |
| Covered from | 9 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 103.80 |
| Total | 103.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000794 | 28 Jun 2026 | 692.00 | NORTHSTAR MUTUAL | Not denied | — |