GRACE ANDERSON
Dependent on policy B02M000189
Claims
2
Attributed to this person
Charged
911.00
Total submitted
Denied
911.00
2 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 ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000189 |
| Date of birth | 11 Nov 2020 |
| Plan | SILVER HMO |
| Covered from | 2 Dec 2024 |
| Covered to | 13 Apr 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 |
|---|---|---|---|---|---|
| CLM0000836 | 22 Feb 2025 | 544.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 544.00 |
| CLM0000835 | 7 Nov 2024 | 367.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 367.00 |