ELENA WILSON
Dependent on policy B06M000614
Claims
2
Attributed to this person
Charged
923.00
Total submitted
Denied
535.00
1 denied claims
Patient responsibility
58.20
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 | ELENA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000614 |
| Date of birth | 14 Jul 2022 |
| Plan | BRONZE EPO |
| Covered from | 6 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 58.20 |
| Total | 58.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002741 | 4 Jul 2026 | 388.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002740 | 5 Feb 2026 | 535.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 535.00 |