IVAN WILSON
Dependent on policy B01M000327
Claims
2
Attributed to this person
Charged
1,401.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | IVAN WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000327 |
| Date of birth | 9 Mar 1955 |
| Plan | BRONZE EPO |
| Covered from | 21 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001453 | 25 Dec 2025 | 726.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001454 | 21 Dec 2025 | 675.00 | NORTHSTAR MUTUAL | Not denied | — |