GRACE ANDERSON
Subscriber on policy B06M000000
Claims
3
Attributed to this person
Charged
1,631.00
Total submitted
Denied
520.00
2 denied claims
Patient responsibility
285.35
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 | GRACE ANDERSON |
| Role on the policy | Subscriber |
| Policy | B06M000000 |
| Date of birth | 23 Jan 1950 |
| Plan | BRONZE EPO |
| Covered from | 27 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 285.35 |
| Total | 285.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000001 | 18 Aug 2025 | 520.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 520.00 |
| CLM0000002 | 20 Jul 2025 | 672.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000003 | 23 Mar 2024 | 439.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |