LEILA WILSON
Dependent on policy B03M000342
Claims
2
Attributed to this person
Charged
1,029.00
Total submitted
Denied
1,029.00
2 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 | LEILA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000342 |
| Date of birth | 29 Jul 1985 |
| Plan | SILVER HMO |
| Covered from | 6 Jun 2025 |
| Covered to | 20 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001379 | 10 Dec 2025 | 201.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 201.00 |
| CLM0001380 | 25 May 2025 | 828.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 828.00 |