SOFIA WILSON
Dependent on policy B10M000556
Claims
2
Attributed to this person
Charged
996.00
Total submitted
Denied
351.00
1 denied claims
Patient responsibility
30.00
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 | SOFIA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000556 |
| Date of birth | 15 Dec 2010 |
| Plan | SILVER HMO |
| Covered from | 23 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002303 | 2 Jun 2026 | 645.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002304 | 1 Jun 2025 | 351.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 351.00 |