SOFIA WILSON
Dependent on policy B06M000789
Claims
1
Attributed to this person
Charged
595.00
Total submitted
Denied
595.00
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 | SOFIA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000789 |
| Date of birth | 30 Dec 2011 |
| Plan | PLATINUM PPO |
| Covered from | 14 Jun 2024 |
| Covered to | 31 Mar 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 |
|---|---|---|---|---|---|
| CLM0003476 | 30 Jul 2024 | 595.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 595.00 |