ELENA PATEL
Dependent on policy B04M000538
Claims
3
Attributed to this person
Charged
1,591.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.55
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 | ELENA PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000538 |
| Date of birth | 31 Dec 1980 |
| Plan | BRONZE EPO |
| Covered from | 9 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.55 |
| Total | 116.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002350 | 2 Apr 2026 | 777.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002352 | 11 Oct 2025 | 256.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002351 | 12 Jul 2025 | 558.00 | NORTHSTAR MUTUAL | Not denied | — |