GRACE WILSON
Subscriber on policy B02M000555
Claims
1
Attributed to this person
Charged
653.00
Total submitted
Denied
11.87
1 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 WILSON |
| Role on the policy | Subscriber |
| Policy | B02M000555 |
| Date of birth | 26 Oct 1961 |
| Plan | BRONZE EPO |
| Covered from | 19 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002345 | 14 Mar 2026 | 653.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 11.87 |