GRACE WILSON
Dependent on policy B07M000647
Claims
3
Attributed to this person
Charged
1,542.00
Total submitted
Denied
735.00
2 denied claims
Patient responsibility
161.40
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 | B07M000647 |
| Date of birth | 3 Aug 2009 |
| Plan | BRONZE EPO |
| Covered from | 15 Nov 2024 |
| Covered to | 11 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 161.40 |
| Total | 161.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002698 | 5 Sep 2025 | 258.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 258.00 |
| CLM0002696 | 8 Apr 2025 | 807.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002697 | 19 Oct 2024 | 477.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 477.00 |