GRACE YAMADA
Dependent on policy B10M000001
Claims
1
Attributed to this person
Charged
368.00
Total submitted
Denied
368.00
1 denied claims
Patient responsibility
0.00
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 | GRACE YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000001 |
| Date of birth | 31 May 1972 |
| Plan | GOLD PPO |
| Covered from | 4 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000015 | 15 Jun 2025 | 368.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 368.00 |