HENRY WILSON
Dependent on policy B03M000774
Claims
2
Attributed to this person
Charged
864.00
Total submitted
Denied
203.23
1 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 | HENRY WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000774 |
| Date of birth | 6 Jan 2017 |
| Plan | SILVER HMO |
| Covered from | 21 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003275 | 19 Aug 2025 | 786.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 203.23 |
| CLM0003276 | 19 Jun 2024 | 78.00 | NORTHSTAR MUTUAL | Not denied | — |