HENRY SMITH
Subscriber on policy B05M000435
Claims
3
Attributed to this person
Charged
2,443.00
Total submitted
Denied
800.00
1 denied claims
Patient responsibility
0.00
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 | HENRY SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000435 |
| Date of birth | 26 Aug 1964 |
| Plan | PLATINUM PPO |
| Covered from | 24 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001831 | 18 May 2026 | 872.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001832 | 16 Mar 2025 | 800.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 800.00 |
| CLM0001833 | 28 Sep 2024 | 771.00 | NORTHSTAR MUTUAL | Not denied | — |