AMARA WILSON
Dependent on policy B03M000742
Claims
2
Attributed to this person
Charged
519.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
33.90
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 | Dependent · relationship 19 |
| Policy | B03M000742 |
| Date of birth | 14 Feb 1997 |
| Plan | SILVER HMO |
| Covered from | 29 May 2024 |
| Covered to | 6 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 33.90 |
| Total | 33.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003114 | 29 Jan 2025 | 293.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003113 | 22 Dec 2024 | 226.00 | NORTHSTAR MUTUAL | Not denied | — |