TOMAS WILSON
Dependent on policy B07M000227
Claims
1
Attributed to this person
Charged
390.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
253.50
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 | TOMAS WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000227 |
| Date of birth | 11 Oct 1984 |
| Plan | PLATINUM PPO |
| Covered from | 17 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 253.50 |
| Total | 253.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000960 | 8 Feb 2025 | 390.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |