GRACE SMITH
Subscriber on policy B03M000777
Claims
2
Attributed to this person
Charged
754.00
Total submitted
Denied
0.00
0 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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000777 |
| Date of birth | 8 Nov 1969 |
| Plan | SILVER HMO |
| Covered from | 24 Jun 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 |
|---|---|---|---|---|---|
| CLM0003298 | 18 Sep 2025 | 629.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003297 | 29 Oct 2024 | 125.00 | NORTHSTAR MUTUAL | Not denied | — |