KEVIN ANDERSON
Dependent on policy B05M000493
Claims
3
Attributed to this person
Charged
1,580.00
Total submitted
Denied
924.00
2 denied claims
Patient responsibility
30.00
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 | KEVIN ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000493 |
| Date of birth | 6 Feb 1992 |
| Plan | GOLD PPO |
| Covered from | 14 Oct 2024 |
| Covered to | 31 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002110 | 20 Sep 2025 | 656.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002109 | 15 Sep 2025 | 220.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 220.00 |
| CLM0002108 | 4 Mar 2025 | 704.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 704.00 |