GRACE USMAN
Subscriber on policy B08M000170
Claims
2
Attributed to this person
Charged
1,072.00
Total submitted
Denied
300.00
1 denied claims
Patient responsibility
115.80
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B08M000170 |
| Date of birth | 1 Dec 1985 |
| Plan | BRONZE EPO |
| Covered from | 15 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 115.80 |
| Total | 115.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000776 | 22 Apr 2026 | 772.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000777 | 22 Dec 2023 | 300.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 300.00 |