GRACE ANDERSON
Subscriber on policy B05M000373
Claims
2
Attributed to this person
Charged
999.00
Total submitted
Denied
139.75
1 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 | GRACE ANDERSON |
| Role on the policy | Subscriber |
| Policy | B05M000373 |
| Date of birth | 5 Jul 2000 |
| Plan | SILVER HMO |
| Covered from | 5 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001588 | 30 Mar 2026 | 480.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001589 | 29 May 2025 | 519.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 139.75 |