GRACE REYES
Dependent on policy B08M000379
Claims
2
Attributed to this person
Charged
1,005.00
Total submitted
Denied
632.00
1 denied claims
Patient responsibility
55.95
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 | B08M000379 |
| Date of birth | 2 Mar 2016 |
| Plan | SILVER HMO |
| Covered from | 11 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.95 |
| Total | 55.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001732 | 28 Feb 2026 | 632.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 632.00 |
| CLM0001733 | 10 Dec 2025 | 373.00 | NORTHSTAR MUTUAL | Not denied | — |