GRACE PATEL
Dependent on policy B06M000840
Claims
2
Attributed to this person
Charged
869.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
119.40
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 PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000840 |
| Date of birth | 5 Jan 2020 |
| Plan | PLATINUM PPO |
| Covered from | 14 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 119.40 |
| Total | 119.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003671 | 25 Dec 2025 | 796.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003672 | 24 Oct 2025 | 73.00 | NORTHSTAR MUTUAL | Not denied | — |