IVAN WILSON
Dependent on policy B05M000674
Claims
2
Attributed to this person
Charged
285.00
Total submitted
Denied
162.29
2 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 | IVAN WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000674 |
| Date of birth | 11 Jun 1966 |
| Plan | BRONZE EPO |
| Covered from | 18 Jun 2025 |
| Covered to | 28 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002907 | 25 Dec 2025 | 129.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 129.00 |
| CLM0002906 | 29 Jul 2025 | 156.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 33.29 |