KEVIN WILSON
Dependent on policy B09M000469
Claims
3
Attributed to this person
Charged
379.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | KEVIN WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000469 |
| Date of birth | 15 Feb 2015 |
| Plan | GOLD PPO |
| Covered from | 26 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001987 | 1 Feb 2025 | 71.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001988 | 26 Nov 2024 | 172.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001989 | 6 Sep 2024 | 136.00 | NORTHSTAR MUTUAL | Not denied | — |