RAVI FOSTER
Dependent on policy B01M000437
Claims
3
Attributed to this person
Charged
2,078.00
Total submitted
Denied
1,392.00
2 denied claims
Patient responsibility
50.00
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 | RAVI FOSTER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000437 |
| Date of birth | 1 Jul 2005 |
| Plan | GOLD PPO |
| Covered from | 16 Jan 2024 |
| Covered to | 6 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001925 | 20 Sep 2024 | 688.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 688.00 |
| CLM0001926 | 27 Aug 2024 | 704.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 704.00 |
| CLM0001924 | 7 May 2024 | 686.00 | NORTHSTAR MUTUAL | Not denied | — |