BRIAN WILSON
Subscriber on policy B01M000158
Claims
1
Attributed to this person
Charged
776.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
155.20
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 | BRIAN WILSON |
| Role on the policy | Subscriber |
| Policy | B01M000158 |
| Date of birth | 28 Nov 1972 |
| Plan | BRONZE EPO |
| Covered from | 19 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 155.20 |
| Total | 155.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000678 | 18 Dec 2025 | 776.00 | CASCADE CARE | Not denied | — |