VICTOR WILSON
Subscriber on policy B03M000128
Claims
3
Attributed to this person
Charged
1,217.00
Total submitted
Denied
211.00
1 denied claims
Patient responsibility
133.20
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 | VICTOR WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000128 |
| Date of birth | 12 Aug 1975 |
| Plan | PLATINUM PPO |
| Covered from | 23 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 133.20 |
| Total | 133.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000512 | 23 Apr 2026 | 888.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000510 | 22 Feb 2024 | 118.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000511 | 12 Jan 2024 | 211.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 211.00 |