IVAN WILSON
Dependent on policy B08M000085
Claims
2
Attributed to this person
Charged
428.00
Total submitted
Denied
106.00
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 | IVAN WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000085 |
| Date of birth | 20 Jun 2023 |
| Plan | SILVER HMO |
| Covered from | 24 Mar 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000376 | 6 Sep 2025 | 322.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000377 | 9 May 2025 | 106.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 106.00 |