RAVI WILSON
Dependent on policy B01M000626
Claims
3
Attributed to this person
Charged
1,085.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
104.80
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 | RAVI WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000626 |
| Date of birth | 21 Oct 2016 |
| Plan | GOLD PPO |
| Covered from | 13 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 104.80 |
| Total | 104.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002797 | 15 Aug 2026 | 344.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002798 | 22 Sep 2025 | 217.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002796 | 6 Aug 2025 | 524.00 | NORTHSTAR MUTUAL | Not denied | — |