GRACE REYES
Dependent on policy B07M000501
Claims
3
Attributed to this person
Charged
822.00
Total submitted
Denied
380.00
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 REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000501 |
| Date of birth | 21 Sep 1995 |
| Plan | GOLD PPO |
| Covered from | 24 Apr 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 |
|---|---|---|---|---|---|
| CLM0002136 | 7 Nov 2025 | 296.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002134 | 20 Jul 2025 | 146.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002135 | 31 Mar 2024 | 380.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 380.00 |