HENRY WILSON
Dependent on policy B08M000279
Claims
1
Attributed to this person
Charged
870.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
130.50
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 | Dependent · relationship 19 |
| Policy | B08M000279 |
| Date of birth | 28 Apr 2010 |
| Plan | SILVER HMO |
| Covered from | 4 Dec 2024 |
| Covered to | 14 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 130.50 |
| Total | 130.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001274 | 15 Oct 2025 | 870.00 | MERIDIAN HEALTH PLAN | Not denied | — |