HENRY YAMADA
Dependent on policy B04M000535
Claims
2
Attributed to this person
Charged
1,521.00
Total submitted
Denied
140.62
2 denied claims
Patient responsibility
540.15
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 | HENRY YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000535 |
| Date of birth | 4 Apr 2008 |
| Plan | PLATINUM PPO |
| Covered from | 29 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 540.15 |
| Total | 540.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002332 | 28 Jan 2026 | 690.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 140.62 |
| CLM0002333 | 8 Jul 2024 | 831.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |