RAVI WILSON
Subscriber on policy B01M000033
Claims
1
Attributed to this person
Charged
353.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
52.95
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 | RAVI WILSON |
| Role on the policy | Subscriber |
| Policy | B01M000033 |
| Date of birth | 6 Jun 1990 |
| Plan | PLATINUM PPO |
| Covered from | 14 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 52.95 |
| Total | 52.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000131 | 4 Aug 2025 | 353.00 | CASCADE CARE | Not denied | — |