CARLA WILSON
Dependent on policy B08M000646
Claims
2
Attributed to this person
Charged
880.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
83.00
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 | CARLA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000646 |
| Date of birth | 19 Jun 1954 |
| Plan | GOLD PPO |
| Covered from | 20 May 2025 |
| Covered to | 15 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 83.00 |
| Total | 83.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002932 | 27 Jul 2025 | 415.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002931 | 14 Jul 2025 | 465.00 | NORTHSTAR MUTUAL | Not denied | — |