UMA YAMADA
Dependent on policy B04M000527
Claims
3
Attributed to this person
Charged
1,803.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
199.40
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 | UMA YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000527 |
| Date of birth | 3 Jul 1966 |
| Plan | BRONZE EPO |
| Covered from | 9 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 2 | 199.40 |
| Total | 199.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002280 | 28 Apr 2026 | 584.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002281 | 14 Jun 2024 | 806.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002279 | 25 May 2024 | 413.00 | NORTHSTAR MUTUAL | Not denied | — |