GRACE REYES
Subscriber on policy B04M000134
Claims
3
Attributed to this person
Charged
958.00
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 REYES |
| Role on the policy | Subscriber |
| Policy | B04M000134 |
| Date of birth | 17 Nov 1975 |
| Plan | BRONZE EPO |
| Covered from | 14 Sep 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 |
|---|---|---|---|---|---|
| CLM0000615 | 10 Jun 2026 | 140.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000614 | 8 May 2026 | 614.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000616 | 2 Aug 2025 | 204.00 | NORTHSTAR MUTUAL | Not denied | — |