TOMAS WILSON
Dependent on policy B02M000065
Claims
2
Attributed to this person
Charged
891.00
Total submitted
Denied
599.00
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 | TOMAS WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000065 |
| Date of birth | 11 Apr 1997 |
| Plan | BRONZE EPO |
| Covered from | 2 Mar 2024 |
| Covered to | 10 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000304 | 24 Aug 2024 | 599.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 599.00 |
| CLM0000303 | 25 Apr 2024 | 292.00 | CASCADE CARE | Not denied | — |