HENRY QUINN
Dependent on policy B01M000256
Claims
2
Attributed to this person
Charged
1,248.00
Total submitted
Denied
272.35
2 denied claims
Patient responsibility
425.10
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 | HENRY QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000256 |
| Date of birth | 25 Mar 1997 |
| Plan | GOLD PPO |
| Covered from | 20 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 425.10 |
| Total | 425.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001088 | 26 Mar 2026 | 594.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 272.35 |
| CLM0001089 | 26 May 2025 | 654.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |