DAVID FOSTER
Dependent on policy B04M000433
Claims
2
Attributed to this person
Charged
965.00
Total submitted
Denied
777.00
1 denied claims
Patient responsibility
28.20
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 FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000433 |
| Date of birth | 11 Apr 2009 |
| Plan | GOLD PPO |
| Covered from | 17 Sep 2024 |
| Covered to | 21 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 28.20 |
| Total | 28.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001871 | 12 Apr 2025 | 777.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 777.00 |
| CLM0001870 | 7 Feb 2025 | 188.00 | NORTHSTAR MUTUAL | Not denied | — |