GRACE YAMADA
Dependent on policy B08M000492
Claims
1
Attributed to this person
Charged
208.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
31.20
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 | GRACE YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000492 |
| Date of birth | 25 Aug 2020 |
| Plan | PLATINUM PPO |
| Covered from | 10 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.20 |
| Total | 31.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002281 | 24 Apr 2026 | 208.00 | NORTHSTAR MUTUAL | Not denied | — |