WENDY REYES
Dependent on policy B05M000743
Claims
1
Attributed to this person
Charged
700.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
140.00
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 | WENDY REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000743 |
| Date of birth | 10 Mar 2017 |
| Plan | BRONZE EPO |
| Covered from | 9 May 2025 |
| Covered to | 18 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 140.00 |
| Total | 140.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003170 | 21 Oct 2025 | 700.00 | NORTHSTAR MUTUAL | Not denied | — |