WENDY WILSON
Subscriber on policy B10M000761
Claims
2
Attributed to this person
Charged
1,274.00
Total submitted
Denied
666.00
1 denied claims
Patient responsibility
15.00
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 | WENDY WILSON |
| Role on the policy | Subscriber |
| Policy | B10M000761 |
| Date of birth | 19 Sep 1971 |
| Plan | GOLD PPO |
| Covered from | 2 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003188 | 30 Mar 2025 | 608.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003189 | 11 May 2024 | 666.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 666.00 |