TOMAS WILSON
Subscriber on policy B03M000055
Claims
3
Attributed to this person
Charged
565.00
Total submitted
Denied
463.00
2 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 | Subscriber |
| Policy | B03M000055 |
| Date of birth | 17 Oct 1951 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jul 2024 |
| Covered to | 13 Oct 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 |
|---|---|---|---|---|---|
| CLM0000235 | 29 Nov 2024 | 190.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 190.00 |
| CLM0000234 | 27 Aug 2024 | 102.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000236 | 14 Jul 2024 | 273.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 273.00 |