HENRY WILSON
Dependent on policy B06M000614
Claims
2
Attributed to this person
Charged
1,163.00
Total submitted
Denied
194.58
1 denied claims
Patient responsibility
0.00
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 | HENRY WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000614 |
| Date of birth | 20 Mar 2012 |
| Plan | BRONZE EPO |
| Covered from | 6 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002738 | 28 Sep 2025 | 861.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 194.58 |
| CLM0002739 | 30 Aug 2025 | 302.00 | NORTHSTAR MUTUAL | Not denied | — |