IVAN WILSON
Dependent on policy B10M000146
Claims
3
Attributed to this person
Charged
1,236.00
Total submitted
Denied
259.52
3 denied claims
Patient responsibility
145.60
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 | IVAN WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000146 |
| Date of birth | 29 Mar 1947 |
| Plan | PLATINUM PPO |
| Covered from | 15 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 145.60 |
| Total | 145.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000605 | 25 Jun 2026 | 522.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 22.73 |
| CLM0000607 | 11 Jul 2025 | 490.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 236.79 |
| CLM0000606 | 25 May 2025 | 224.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |