SOFIA WILSON
Subscriber on policy B08M000489
Claims
3
Attributed to this person
Charged
1,979.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
495.95
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 | SOFIA WILSON |
| Role on the policy | Subscriber |
| Policy | B08M000489 |
| Date of birth | 10 May 1983 |
| Plan | GOLD PPO |
| Covered from | 29 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 495.95 |
| Total | 495.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002264 | 7 Aug 2026 | 809.00 | CASCADE CARE | Not denied | — |
| CLM0002263 | 20 Feb 2026 | 763.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002262 | 24 Nov 2024 | 407.00 | CASCADE CARE | Not denied | — |