ZARA YAMADA
Dependent on policy B01M000165
Claims
3
Attributed to this person
Charged
1,454.00
Total submitted
Denied
867.00
1 denied claims
Patient responsibility
57.60
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 | ZARA YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000165 |
| Date of birth | 20 Sep 1954 |
| Plan | SILVER HMO |
| Covered from | 4 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 57.60 |
| Total | 57.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000707 | 27 Apr 2026 | 288.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000709 | 27 Mar 2026 | 299.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000708 | 6 Apr 2025 | 867.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 867.00 |