SOFIA WILSON
Dependent on policy B04M000196
Claims
2
Attributed to this person
Charged
1,359.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
536.25
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 | SOFIA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000196 |
| Date of birth | 21 Nov 1979 |
| Plan | BRONZE EPO |
| Covered from | 26 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 536.25 |
| Total | 536.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000872 | 9 Sep 2025 | 825.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000873 | 17 Mar 2025 | 534.00 | CASCADE CARE | Not denied | — |