IVAN HUGHES
Subscriber on policy B05M000763
Claims
3
Attributed to this person
Charged
1,382.00
Total submitted
Denied
34.49
1 denied claims
Patient responsibility
132.45
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 | IVAN HUGHES |
| Role on the policy | Subscriber |
| Policy | B05M000763 |
| Date of birth | 4 Mar 1977 |
| Plan | BRONZE EPO |
| Covered from | 5 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 132.45 |
| Total | 132.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003271 | 26 Jun 2026 | 117.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 34.49 |
| CLM0003272 | 23 Dec 2025 | 883.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003273 | 29 Jun 2024 | 382.00 | NORTHSTAR MUTUAL | Not denied | — |