TOMAS WILSON
Dependent on policy B09M000775
Claims
2
Attributed to this person
Charged
1,060.00
Total submitted
Denied
678.24
2 denied claims
Patient responsibility
0.00
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 | TOMAS WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000775 |
| Date of birth | 22 Apr 2005 |
| Plan | PLATINUM PPO |
| Covered from | 17 Nov 2024 |
| Covered to | 19 Jun 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003282 | 1 Jun 2025 | 661.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 279.24 |
| CLM0003281 | 24 Oct 2024 | 399.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 399.00 |