DAVID WILSON
Dependent on policy B01M000308
Claims
3
Attributed to this person
Charged
1,810.00
Total submitted
Denied
947.81
2 denied claims
Patient responsibility
85.65
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 | B01M000308 |
| Date of birth | 17 Jun 1984 |
| Plan | GOLD PPO |
| Covered from | 24 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 85.65 |
| Total | 85.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001362 | 25 Oct 2025 | 376.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 84.81 |
| CLM0001364 | 24 Aug 2025 | 863.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 863.00 |
| CLM0001363 | 6 Jul 2025 | 571.00 | MERIDIAN HEALTH PLAN | Not denied | — |