ELENA WILSON
Subscriber on policy B10M000712
Claims
2
Attributed to this person
Charged
1,279.00
Total submitted
Denied
606.00
1 denied claims
Patient responsibility
134.60
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 | ELENA WILSON |
| Role on the policy | Subscriber |
| Policy | B10M000712 |
| Date of birth | 28 Aug 1974 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 134.60 |
| Total | 134.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002985 | 29 Mar 2025 | 673.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002986 | 11 Jan 2025 | 606.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 606.00 |