WENDY WILSON
Dependent on policy B03M000126
Claims
2
Attributed to this person
Charged
849.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
35.40
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 | WENDY WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000126 |
| Date of birth | 11 Sep 1992 |
| Plan | BRONZE EPO |
| Covered from | 30 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 35.40 |
| Total | 35.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000502 | 13 Aug 2026 | 613.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000501 | 16 Jan 2026 | 236.00 | NORTHSTAR MUTUAL | Not denied | — |