LEILA WILSON
Subscriber on policy B03M000722
Claims
3
Attributed to this person
Charged
1,730.00
Total submitted
Denied
762.00
1 denied claims
Patient responsibility
171.00
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 | LEILA WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000722 |
| Date of birth | 31 Mar 1973 |
| Plan | PLATINUM PPO |
| Covered from | 30 Jun 2024 |
| Covered to | 19 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 171.00 |
| Total | 171.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003016 | 3 Nov 2024 | 855.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003017 | 2 Nov 2024 | 762.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 762.00 |
| CLM0003015 | 11 Sep 2024 | 113.00 | MERIDIAN HEALTH PLAN | Not denied | — |