OMAR WILSON
Dependent on policy B07M000264
Claims
1
Attributed to this person
Charged
801.00
Total submitted
Denied
801.00
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 | OMAR WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000264 |
| Date of birth | 9 Dec 1962 |
| 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 |
|---|---|---|---|---|---|
| CLM0001134 | 1 May 2024 | 801.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 801.00 |