NADIA WILSON
Dependent on policy B03M000742
Claims
3
Attributed to this person
Charged
1,852.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | NADIA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000742 |
| Date of birth | 20 Jul 1970 |
| Plan | SILVER HMO |
| Covered from | 29 May 2024 |
| Covered to | 6 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003111 | 29 Dec 2024 | 825.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003110 | 22 Nov 2024 | 732.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003112 | 3 May 2024 | 295.00 | NORTHSTAR MUTUAL | Not denied | — |