OMAR WILSON
Subscriber on policy B03M000486
Claims
3
Attributed to this person
Charged
1,592.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
121.55
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 | OMAR WILSON |
| Role on the policy | Subscriber |
| Policy | B03M000486 |
| Date of birth | 2 Feb 1955 |
| Plan | SILVER HMO |
| Covered from | 27 May 2024 |
| Covered to | 3 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 121.55 |
| Total | 121.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002024 | 28 Oct 2024 | 844.00 | CASCADE CARE | Not denied | — |
| CLM0002023 | 30 Jun 2024 | 187.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002025 | 15 Jun 2024 | 561.00 | CASCADE CARE | Not denied | — |