FIONA WILSON
Dependent on policy B09M000835
Claims
2
Attributed to this person
Charged
903.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
78.00
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 | FIONA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000835 |
| Date of birth | 29 Feb 2008 |
| Plan | SILVER HMO |
| Covered from | 10 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 78.00 |
| Total | 78.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003555 | 17 Mar 2026 | 513.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003554 | 19 Jan 2026 | 390.00 | NORTHSTAR MUTUAL | Not denied | — |