GRACE QUINN
Dependent on policy B05M000110
Claims
3
Attributed to this person
Charged
860.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
27.30
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 QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000110 |
| Date of birth | 2 Dec 1976 |
| Plan | SILVER HMO |
| Covered from | 17 Oct 2024 |
| Covered to | 14 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 27.30 |
| Total | 27.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000464 | 20 Mar 2025 | 182.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000465 | 11 Dec 2024 | 178.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000463 | 4 Nov 2024 | 500.00 | NORTHSTAR MUTUAL | Not denied | — |