DAVID WILSON
Dependent on policy B02M000504
Claims
2
Attributed to this person
Charged
728.00
Total submitted
Denied
646.00
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 | DAVID WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000504 |
| Date of birth | 3 Jun 1974 |
| Plan | BRONZE EPO |
| Covered from | 31 Mar 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 |
|---|---|---|---|---|---|
| CLM0002142 | 20 Oct 2024 | 82.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002141 | 4 Mar 2024 | 646.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 646.00 |