IVAN ANDERSON
Subscriber on policy B05M000058
Claims
1
Attributed to this person
Charged
261.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
52.20
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 | IVAN ANDERSON |
| Role on the policy | Subscriber |
| Policy | B05M000058 |
| Date of birth | 11 Nov 1975 |
| Plan | GOLD PPO |
| Covered from | 29 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 52.20 |
| Total | 52.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000280 | 25 Jan 2025 | 261.00 | NORTHSTAR MUTUAL | Not denied | — |