OMAR WILSON
Subscriber on policy B08M000180
Claims
1
Attributed to this person
Charged
417.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
271.05
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 | Subscriber |
| Policy | B08M000180 |
| Date of birth | 8 Jul 1995 |
| Plan | BRONZE EPO |
| Covered from | 7 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 271.05 |
| Total | 271.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000808 | 7 Dec 2024 | 417.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |