ZARA ANDERSON
Subscriber on policy B01M000366
Claims
3
Attributed to this person
Charged
1,419.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
250.10
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 | ZARA ANDERSON |
| Role on the policy | Subscriber |
| Policy | B01M000366 |
| Date of birth | 15 Dec 1974 |
| Plan | BRONZE EPO |
| Covered from | 24 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 230.10 |
| CARC 3 · Copay | 1 | 20.00 |
| Total | 250.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001626 | 22 Apr 2026 | 833.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001624 | 29 Nov 2025 | 232.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001625 | 19 Sep 2024 | 354.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |