VICTOR REYES
Dependent on policy B05M000087
Claims
2
Attributed to this person
Charged
1,332.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
122.40
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 | VICTOR REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000087 |
| Date of birth | 4 Nov 1974 |
| Plan | GOLD PPO |
| Covered from | 8 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 122.40 |
| Total | 122.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000393 | 13 Nov 2025 | 612.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000392 | 2 Feb 2025 | 720.00 | NORTHSTAR MUTUAL | Not denied | — |