PRIYA WILSON
Subscriber on policy B06M000216
Claims
2
Attributed to this person
Charged
1,198.00
Total submitted
Denied
857.00
1 denied claims
Patient responsibility
51.15
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 | PRIYA WILSON |
| Role on the policy | Subscriber |
| Policy | B06M000216 |
| Date of birth | 30 Jun 1984 |
| Plan | GOLD PPO |
| Covered from | 30 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.15 |
| Total | 51.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001032 | 9 Apr 2026 | 857.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 857.00 |
| CLM0001031 | 15 May 2025 | 341.00 | NORTHSTAR MUTUAL | Not denied | — |