ELENA REYES
Subscriber on policy B04M000585
Claims
3
Attributed to this person
Charged
2,066.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.40
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 | ELENA REYES |
| Role on the policy | Subscriber |
| Policy | B04M000585 |
| Date of birth | 22 Apr 1988 |
| Plan | SILVER HMO |
| Covered from | 15 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 116.40 |
| Total | 116.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002563 | 7 May 2026 | 582.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002565 | 25 Jan 2026 | 897.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002564 | 27 Apr 2025 | 587.00 | NORTHSTAR MUTUAL | Not denied | — |