FIONA WILSON
Subscriber on policy B06M000150
Claims
2
Attributed to this person
Charged
1,123.00
Total submitted
Denied
0.00
0 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 | FIONA WILSON |
| Role on the policy | Subscriber |
| Policy | B06M000150 |
| Date of birth | 5 Dec 1981 |
| Plan | SILVER HMO |
| Covered from | 8 Oct 2024 |
| Covered to | 28 May 2025 |
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 |
|---|---|---|---|---|---|
| CLM0000734 | 26 Jun 2025 | 745.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000733 | 22 Nov 2024 | 378.00 | NORTHSTAR MUTUAL | Not denied | — |