ELENA ANDERSON
Dependent on policy B05M000334
Claims
2
Attributed to this person
Charged
937.00
Total submitted
Denied
232.00
2 denied claims
Patient responsibility
458.25
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 | ELENA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000334 |
| Date of birth | 8 Apr 1995 |
| Plan | PLATINUM PPO |
| Covered from | 28 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 458.25 |
| Total | 458.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001420 | 19 Jul 2026 | 705.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001421 | 11 Dec 2025 | 232.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 232.00 |