RAVI WILSON
Dependent on policy B10M000172
Claims
2
Attributed to this person
Charged
1,157.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
86.70
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 | RAVI WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000172 |
| Date of birth | 12 Nov 1968 |
| Plan | GOLD PPO |
| Covered from | 28 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 86.70 |
| Total | 86.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000717 | 25 Apr 2026 | 579.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000716 | 17 Dec 2024 | 578.00 | NORTHSTAR MUTUAL | Not denied | — |