ELENA WILSON
Dependent on policy B10M000556
Claims
2
Attributed to this person
Charged
449.00
Total submitted
Denied
128.71
1 denied claims
Patient responsibility
17.40
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 | ELENA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000556 |
| Date of birth | 15 Apr 1979 |
| Plan | SILVER HMO |
| Covered from | 23 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 17.40 |
| Total | 17.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002301 | 8 Feb 2026 | 362.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 128.71 |
| CLM0002302 | 8 Jul 2025 | 87.00 | MERIDIAN HEALTH PLAN | Not denied | — |