AMARA WILSON
Subscriber on policy B03M000126
Claims
1
Attributed to this person
Charged
246.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
159.90
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 | AMARA WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000126 |
| Date of birth | 3 Jun 1993 |
| Plan | BRONZE EPO |
| Covered from | 30 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 159.90 |
| Total | 159.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000500 | 18 May 2025 | 246.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |