UMA WILSON
Dependent on policy B02M000018
Claims
1
Attributed to this person
Charged
649.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
97.35
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 | UMA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000018 |
| Date of birth | 15 May 1998 |
| Plan | BRONZE EPO |
| Covered from | 19 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 97.35 |
| Total | 97.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000109 | 1 Apr 2025 | 649.00 | MERIDIAN HEALTH PLAN | Not denied | — |