PRIYA WILSON
Dependent on policy B01M000848
Claims
3
Attributed to this person
Charged
1,132.00
Total submitted
Denied
349.00
1 denied claims
Patient responsibility
15.00
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 | PRIYA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000848 |
| Date of birth | 16 Apr 1985 |
| Plan | BRONZE EPO |
| Covered from | 7 Oct 2024 |
| Covered to | 25 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003760 | 18 Mar 2025 | 259.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003761 | 26 Feb 2025 | 524.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003759 | 10 Sep 2024 | 349.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 349.00 |