GRACE FOSTER
Subscriber on policy B01M000081
Claims
2
Attributed to this person
Charged
733.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
142.95
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 FOSTER |
| Role on the policy | Subscriber |
| Policy | B01M000081 |
| Date of birth | 20 Dec 1965 |
| Plan | BRONZE EPO |
| Covered from | 8 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 100.05 |
| CARC 50 · Other | 1 | 42.90 |
| Total | 142.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000330 | 18 May 2026 | 667.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000329 | 13 Dec 2024 | 66.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |