HENRY FOSTER
Dependent on policy B05M000888
Claims
3
Attributed to this person
Charged
1,155.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
12.45
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 | HENRY FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000888 |
| Date of birth | 23 Dec 1999 |
| Plan | GOLD PPO |
| Covered from | 19 Jun 2024 |
| Covered to | 2 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 12.45 |
| Total | 12.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003781 | 2 Mar 2025 | 83.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003780 | 21 Feb 2025 | 364.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003782 | 18 Jul 2024 | 708.00 | NORTHSTAR MUTUAL | Not denied | — |