GRACE FOSTER
Dependent on policy B08M000407
Claims
1
Attributed to this person
Charged
385.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
15.00
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 FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000407 |
| Date of birth | 17 Jun 1955 |
| Plan | GOLD PPO |
| Covered from | 29 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001872 | 18 Jul 2025 | 385.00 | NORTHSTAR MUTUAL | Not denied | — |