FIONA WILSON
Dependent on policy B08M000468
Claims
2
Attributed to this person
Charged
878.00
Total submitted
Denied
346.18
1 denied claims
Patient responsibility
25.20
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 | FIONA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000468 |
| Date of birth | 2 Oct 1995 |
| 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 | 25.20 |
| Total | 25.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002167 | 19 Jul 2026 | 126.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002168 | 13 Jul 2025 | 752.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 346.18 |