GRACE MURPHY
Dependent on policy B04M000858
Claims
1
Attributed to this person
Charged
327.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
65.40
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 MURPHY |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000858 |
| Date of birth | 6 Nov 2023 |
| Plan | GOLD PPO |
| Covered from | 21 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 65.40 |
| Total | 65.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003715 | 14 Mar 2025 | 327.00 | NORTHSTAR MUTUAL | Not denied | — |