GRACE HUGHES
Subscriber on policy B03M000834
Claims
1
Attributed to this person
Charged
100.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
65.00
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 HUGHES |
| Role on the policy | Subscriber |
| Policy | B03M000834 |
| Date of birth | 31 Dec 1980 |
| Plan | GOLD PPO |
| Covered from | 21 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 65.00 |
| Total | 65.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003593 | 26 Mar 2025 | 100.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |