CARLA WILSON
Dependent on policy B04M000792
Claims
2
Attributed to this person
Charged
1,602.00
Total submitted
Denied
1,602.00
2 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 | CARLA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000792 |
| Date of birth | 13 Jun 1967 |
| Plan | SILVER HMO |
| Covered from | 8 May 2025 |
| Covered to | 20 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003457 | 12 Oct 2025 | 831.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 831.00 |
| CLM0003458 | 24 Sep 2025 | 771.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 771.00 |