FIONA WILSON
Dependent on policy B01M000604
Claims
1
Attributed to this person
Charged
389.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
77.80
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 | Dependent · relationship 01 |
| Policy | B01M000604 |
| Date of birth | 30 Oct 1992 |
| Plan | SILVER HMO |
| Covered from | 7 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 77.80 |
| Total | 77.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002687 | 29 May 2025 | 389.00 | NORTHSTAR MUTUAL | Not denied | — |