BRIAN WILSON
Subscriber on policy B08M000266
Claims
2
Attributed to this person
Charged
310.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
28.60
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 | B08M000266 |
| Date of birth | 25 Mar 1952 |
| Plan | GOLD PPO |
| Covered from | 6 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 28.60 |
| Total | 28.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001204 | 27 Jun 2026 | 167.00 | CASCADE CARE | Not denied | — |
| CLM0001203 | 18 Nov 2025 | 143.00 | CASCADE CARE | Not denied | — |