GRACE YAMADA
Subscriber on policy B09M000308
Claims
3
Attributed to this person
Charged
1,686.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
423.15
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 | Subscriber |
| Policy | B09M000308 |
| Date of birth | 1 Nov 1986 |
| Plan | SILVER HMO |
| Covered from | 9 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 423.15 |
| Total | 423.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001261 | 5 Feb 2026 | 234.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001263 | 22 May 2025 | 801.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001262 | 28 Apr 2025 | 651.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |