AMARA WILSON
Dependent on policy B06M000179
Claims
1
Attributed to this person
Charged
559.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
111.80
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 | AMARA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000179 |
| Date of birth | 18 Jan 2016 |
| Plan | GOLD PPO |
| Covered from | 29 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 111.80 |
| Total | 111.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000876 | 12 Aug 2025 | 559.00 | CASCADE CARE | Not denied | — |