UMA REYES
Dependent on policy B05M000069
Claims
2
Attributed to this person
Charged
1,091.00
Total submitted
Denied
339.00
1 denied claims
Patient responsibility
150.40
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 | UMA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000069 |
| Date of birth | 26 Jan 1972 |
| Plan | BRONZE EPO |
| Covered from | 26 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 150.40 |
| Total | 150.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000324 | 25 Jun 2026 | 752.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000323 | 30 May 2025 | 339.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 339.00 |