GRACE IQBAL
Subscriber on policy B02M000685
Claims
2
Attributed to this person
Charged
958.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
77.35
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 IQBAL |
| Role on the policy | Subscriber |
| Policy | B02M000685 |
| Date of birth | 23 Aug 1972 |
| Plan | GOLD PPO |
| Covered from | 20 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 77.35 |
| Total | 77.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002890 | 3 Jul 2026 | 119.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002891 | 22 Nov 2024 | 839.00 | NORTHSTAR MUTUAL | Not denied | — |