FIONA WILSON
Subscriber on policy B10M000813
Claims
2
Attributed to this person
Charged
1,201.00
Total submitted
Denied
479.00
1 denied claims
Patient responsibility
144.40
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 | Subscriber |
| Policy | B10M000813 |
| Date of birth | 23 Apr 1996 |
| Plan | BRONZE EPO |
| Covered from | 8 May 2025 |
| Covered to | 28 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 144.40 |
| Total | 144.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003439 | 26 Nov 2025 | 722.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003440 | 3 Nov 2025 | 479.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 479.00 |