KEVIN WILSON
Dependent on policy B03M000642
Claims
2
Attributed to this person
Charged
853.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
217.10
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 | KEVIN WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000642 |
| Date of birth | 31 Jul 2011 |
| Plan | BRONZE EPO |
| Covered from | 16 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 217.10 |
| Total | 217.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002662 | 2 Nov 2024 | 519.00 | CASCADE CARE | Not denied | — |
| CLM0002661 | 4 Oct 2024 | 334.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |