PRIYA WILSON
Subscriber on policy B03M000342
Claims
1
Attributed to this person
Charged
598.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
89.70
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 | PRIYA WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000342 |
| Date of birth | 10 Aug 1959 |
| Plan | SILVER HMO |
| Covered from | 6 Jun 2025 |
| Covered to | 20 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 89.70 |
| Total | 89.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001375 | 2 Sep 2025 | 598.00 | NORTHSTAR MUTUAL | Not denied | — |