VICTOR ANDERSON
Subscriber on policy B01M000167
Claims
3
Attributed to this person
Charged
1,081.00
Total submitted
Denied
399.00
2 denied claims
Patient responsibility
102.30
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 | Subscriber |
| Policy | B01M000167 |
| Date of birth | 25 May 1994 |
| Plan | GOLD PPO |
| Covered from | 24 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 102.30 |
| Total | 102.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000714 | 16 Jul 2026 | 84.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 84.00 |
| CLM0000715 | 7 Dec 2025 | 682.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000716 | 22 Aug 2024 | 315.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 315.00 |