LEILA WILSON
Subscriber on policy B10M000077
Claims
3
Attributed to this person
Charged
2,531.00
Total submitted
Denied
281.65
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 | LEILA WILSON |
| Role on the policy | Subscriber |
| Policy | B10M000077 |
| Date of birth | 12 Mar 1952 |
| Plan | SILVER HMO |
| Covered from | 5 May 2024 |
| Covered to | 1 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000322 | 19 Dec 2024 | 767.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000321 | 18 Sep 2024 | 894.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000320 | 8 Sep 2024 | 870.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 281.65 |