HENRY WILSON
Subscriber on policy B07M000264
Claims
2
Attributed to this person
Charged
1,410.00
Total submitted
Denied
1,410.00
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 | HENRY WILSON |
| Role on the policy | Subscriber |
| Policy | B07M000264 |
| Date of birth | 6 Sep 1971 |
| Plan | PLATINUM PPO |
| Covered from | 15 Jan 2024 |
| Covered to | 21 Apr 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001132 | 1 May 2024 | 749.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 749.00 |
| CLM0001133 | 24 Feb 2024 | 661.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 661.00 |