SOFIA TANAKA
Dependent on policy B04M000798
Claims
3
Attributed to this person
Charged
1,468.00
Total submitted
Denied
661.00
1 denied claims
Patient responsibility
0.00
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 | SOFIA TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000798 |
| Date of birth | 26 Sep 1961 |
| Plan | GOLD PPO |
| Covered from | 25 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003483 | 15 Dec 2025 | 392.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003484 | 10 Jun 2025 | 661.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 661.00 |
| CLM0003485 | 26 May 2025 | 415.00 | NORTHSTAR MUTUAL | Not denied | — |