GRACE WILSON
Dependent on policy B06M000800
Claims
3
Attributed to this person
Charged
889.00
Total submitted
Denied
765.00
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 | GRACE WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000800 |
| Date of birth | 24 Jan 1973 |
| Plan | SILVER HMO |
| Covered from | 5 May 2025 |
| Covered to | 3 Sep 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 |
|---|---|---|---|---|---|
| CLM0003517 | 26 Sep 2025 | 545.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 545.00 |
| CLM0003519 | 21 Sep 2025 | 220.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 220.00 |
| CLM0003518 | 10 May 2025 | 124.00 | CASCADE CARE | Not denied | — |