DAVID WILSON
Subscriber on policy B01M000376
Claims
1
Attributed to this person
Charged
481.00
Total submitted
Denied
234.90
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 | Subscriber |
| Policy | B01M000376 |
| Date of birth | 27 Feb 1957 |
| Plan | GOLD PPO |
| Covered from | 14 Dec 2024 |
| Covered to | 27 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001662 | 20 Dec 2024 | 481.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 234.90 |