CARLA HUGHES
Subscriber on policy B05M000077
Claims
1
Attributed to this person
Charged
872.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
566.80
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 | CARLA HUGHES |
| Role on the policy | Subscriber |
| Policy | B05M000077 |
| Date of birth | 14 Jan 1999 |
| Plan | PLATINUM PPO |
| Covered from | 4 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 566.80 |
| Total | 566.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000358 | 28 Mar 2025 | 872.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |