SOFIA WILSON
Subscriber on policy B08M000468
Claims
2
Attributed to this person
Charged
558.00
Total submitted
Denied
332.00
1 denied claims
Patient responsibility
45.20
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 | SOFIA WILSON |
| Role on the policy | Subscriber |
| Policy | B08M000468 |
| Date of birth | 30 Jun 1957 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 45.20 |
| Total | 45.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002161 | 20 Jul 2025 | 226.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002162 | 14 Dec 2024 | 332.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 332.00 |