GRACE REYES
Dependent on policy B07M000254
Claims
3
Attributed to this person
Charged
999.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
27.00
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 REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000254 |
| Date of birth | 9 Jun 2015 |
| Plan | BRONZE EPO |
| Covered from | 4 May 2025 |
| Covered to | 10 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 27.00 |
| Total | 27.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001092 | 27 Oct 2025 | 180.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001091 | 16 Oct 2025 | 636.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001090 | 4 Aug 2025 | 183.00 | NORTHSTAR MUTUAL | Not denied | — |