GRACE KUMAR
Subscriber on policy B04M000431
Claims
3
Attributed to this person
Charged
930.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
85.05
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 KUMAR |
| Role on the policy | Subscriber |
| Policy | B04M000431 |
| Date of birth | 20 Apr 2000 |
| Plan | GOLD PPO |
| Covered from | 27 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 85.05 |
| Total | 85.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001849 | 6 Jul 2026 | 108.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001851 | 25 Jan 2026 | 255.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001850 | 27 Apr 2025 | 567.00 | NORTHSTAR MUTUAL | Not denied | — |