GRACE WILSON
Subscriber on policy B06M000635
Claims
2
Attributed to this person
Charged
901.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
47.40
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 WILSON |
| Role on the policy | Subscriber |
| Policy | B06M000635 |
| Date of birth | 25 Jun 1986 |
| Plan | BRONZE EPO |
| Covered from | 29 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 47.40 |
| Total | 47.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002835 | 28 Aug 2025 | 316.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002834 | 18 Jul 2025 | 585.00 | NORTHSTAR MUTUAL | Not denied | — |