GRACE HUGHES
Subscriber on policy B02M000403
Claims
3
Attributed to this person
Charged
807.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
26.85
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 HUGHES |
| Role on the policy | Subscriber |
| Policy | B02M000403 |
| Date of birth | 25 May 2003 |
| Plan | BRONZE EPO |
| Covered from | 13 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 26.85 |
| Total | 26.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001730 | 30 Oct 2025 | 179.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001729 | 14 May 2025 | 153.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001731 | 17 Jan 2025 | 475.00 | NORTHSTAR MUTUAL | Not denied | — |