AMARA WILSON
Subscriber on policy B02M000358
Claims
2
Attributed to this person
Charged
681.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
58.95
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 | AMARA WILSON |
| Role on the policy | Subscriber |
| Policy | B02M000358 |
| Date of birth | 15 Jan 1996 |
| Plan | PLATINUM PPO |
| Covered from | 28 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 58.95 |
| Total | 58.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001531 | 30 Dec 2024 | 393.00 | CASCADE CARE | Not denied | — |
| CLM0001530 | 5 Dec 2024 | 288.00 | CASCADE CARE | Not denied | — |