GRACE HUGHES
Dependent on policy B05M000326
Claims
2
Attributed to this person
Charged
869.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
106.20
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 HUGHES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000326 |
| Date of birth | 5 Aug 2010 |
| Plan | BRONZE EPO |
| Covered from | 21 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 106.20 |
| Total | 106.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001372 | 7 Sep 2025 | 161.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001371 | 31 Jul 2025 | 708.00 | NORTHSTAR MUTUAL | Not denied | — |