CARLA WILSON
Subscriber on policy B01M000869
Claims
2
Attributed to this person
Charged
1,244.00
Total submitted
Denied
0.00
0 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 | CARLA WILSON |
| Role on the policy | Subscriber |
| Policy | B01M000869 |
| Date of birth | 19 Jun 1950 |
| Plan | GOLD PPO |
| Covered from | 20 Feb 2025 |
| Covered to | 6 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003854 | 22 Apr 2025 | 576.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003853 | 4 Mar 2025 | 668.00 | NORTHSTAR MUTUAL | Not denied | — |