IVAN WILSON
Dependent on policy B09M000510
Claims
2
Attributed to this person
Charged
762.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
128.40
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 | IVAN WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000510 |
| Date of birth | 18 Sep 1993 |
| Plan | PLATINUM PPO |
| Covered from | 9 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 128.40 |
| Total | 128.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002166 | 20 May 2025 | 642.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002165 | 14 Apr 2024 | 120.00 | MERIDIAN HEALTH PLAN | Not denied | — |