NADIA WILSON
Dependent on policy B03M000722
Claims
2
Attributed to this person
Charged
805.00
Total submitted
Denied
488.00
1 denied claims
Patient responsibility
47.55
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 | NADIA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000722 |
| Date of birth | 12 Sep 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 1 · Deductible | 1 | 47.55 |
| Total | 47.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003019 | 19 Jan 2025 | 488.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 488.00 |
| CLM0003018 | 11 Dec 2024 | 317.00 | MERIDIAN HEALTH PLAN | Not denied | — |