ELENA WILSON
Dependent on policy B07M000389
Claims
1
Attributed to this person
Charged
844.00
Total submitted
Denied
844.00
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 | ELENA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000389 |
| Date of birth | 14 Jun 1984 |
| Plan | PLATINUM PPO |
| Covered from | 23 Jun 2025 |
| Covered to | 25 Nov 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 |
|---|---|---|---|---|---|
| CLM0001657 | 12 Jun 2025 | 844.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 844.00 |