WENDY IQBAL
Subscriber on policy B04M000702
Claims
2
Attributed to this person
Charged
1,026.00
Total submitted
Denied
141.79
1 denied claims
Patient responsibility
147.80
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 | WENDY IQBAL |
| Role on the policy | Subscriber |
| Policy | B04M000702 |
| Date of birth | 29 May 1982 |
| Plan | PLATINUM PPO |
| Covered from | 2 Jan 2024 |
| Covered to | 29 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 147.80 |
| Total | 147.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003053 | 31 May 2024 | 739.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003052 | 3 May 2024 | 287.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 141.79 |