KEVIN WILSON
Subscriber on policy B02M000065
Claims
2
Attributed to this person
Charged
1,402.00
Total submitted
Denied
862.00
1 denied claims
Patient responsibility
81.00
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 | KEVIN WILSON |
| Role on the policy | Subscriber |
| Policy | B02M000065 |
| Date of birth | 24 Mar 1988 |
| Plan | BRONZE EPO |
| Covered from | 2 Mar 2024 |
| Covered to | 10 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 81.00 |
| Total | 81.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000302 | 8 Sep 2024 | 862.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 862.00 |
| CLM0000301 | 27 Feb 2024 | 540.00 | CASCADE CARE | Not denied | — |