YUSUF WILSON
Dependent on policy B03M000844
Claims
2
Attributed to this person
Charged
883.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | YUSUF WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000844 |
| Date of birth | 20 May 2014 |
| Plan | GOLD PPO |
| Covered from | 28 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003659 | 18 Jul 2025 | 472.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003658 | 18 Jun 2025 | 411.00 | NORTHSTAR MUTUAL | Not denied | — |