HENRY FOSTER
Subscriber on policy B04M000639
Claims
3
Attributed to this person
Charged
2,142.00
Total submitted
Denied
474.00
2 denied claims
Patient responsibility
566.15
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 FOSTER |
| Role on the policy | Subscriber |
| Policy | B04M000639 |
| Date of birth | 15 Feb 1995 |
| Plan | PLATINUM PPO |
| Covered from | 20 Jun 2024 |
| Covered to | 3 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 566.15 |
| Total | 566.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002770 | 12 Feb 2025 | 474.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 474.00 |
| CLM0002769 | 24 Jun 2024 | 797.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002771 | 4 Jun 2024 | 871.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |