ELENA WILSON
Dependent on policy B10M000762
Claims
1
Attributed to this person
Charged
170.00
Total submitted
Denied
170.00
1 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 | ELENA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000762 |
| Date of birth | 30 Mar 2006 |
| Plan | GOLD PPO |
| Covered from | 12 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003196 | 5 May 2025 | 170.00 | CASCADE CARE | CARC 11 · CODING | 170.00 |