OMAR WILSON
Subscriber on policy B03M000316
Claims
1
Attributed to this person
Charged
150.00
Total submitted
Denied
150.00
1 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 | OMAR WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000316 |
| Date of birth | 4 Feb 1985 |
| Plan | PLATINUM PPO |
| Covered from | 17 Jan 2025 |
| Covered to | 8 May 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001263 | 16 May 2025 | 150.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 150.00 |