TOMAS WILSON
Dependent on policy B07M000552
Claims
3
Attributed to this person
Charged
1,151.00
Total submitted
Denied
308.00
1 denied claims
Patient responsibility
70.80
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 | TOMAS WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000552 |
| Date of birth | 1 Dec 1963 |
| Plan | PLATINUM PPO |
| Covered from | 25 Mar 2025 |
| Covered to | 22 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 70.80 |
| Total | 70.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002352 | 20 Jun 2025 | 489.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002353 | 11 May 2025 | 354.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002351 | 16 Mar 2025 | 308.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 308.00 |