LEILA PATEL
Dependent on policy B01M000460
Claims
3
Attributed to this person
Charged
2,031.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
150.40
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 | LEILA PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000460 |
| Date of birth | 31 Aug 2022 |
| Plan | GOLD PPO |
| Covered from | 17 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 150.40 |
| Total | 150.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002062 | 17 Jul 2026 | 752.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002060 | 29 Oct 2025 | 466.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002061 | 1 Sep 2025 | 813.00 | NORTHSTAR MUTUAL | Not denied | — |