VICTOR ANDERSON
Dependent on policy B04M000658
Claims
3
Attributed to this person
Charged
1,290.00
Total submitted
Denied
588.00
1 denied claims
Patient responsibility
40.00
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 | VICTOR ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000658 |
| Date of birth | 21 Jan 1994 |
| Plan | SILVER HMO |
| Covered from | 20 Nov 2024 |
| Covered to | 5 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002870 | 25 Aug 2025 | 429.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002871 | 10 Aug 2025 | 273.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002869 | 12 Nov 2024 | 588.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 588.00 |