GRACE WILSON
Dependent on policy B01M000626
Claims
2
Attributed to this person
Charged
745.00
Total submitted
Denied
320.00
1 denied claims
Patient responsibility
0.00
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 | Dependent · relationship 19 |
| Policy | B01M000626 |
| Date of birth | 5 Oct 2017 |
| Plan | GOLD PPO |
| Covered from | 13 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002800 | 15 Jun 2026 | 320.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 320.00 |
| CLM0002799 | 16 Nov 2024 | 425.00 | NORTHSTAR MUTUAL | Not denied | — |