OMAR WILSON
Subscriber on policy B04M000405
Claims
3
Attributed to this person
Charged
1,189.00
Total submitted
Denied
243.85
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 | B04M000405 |
| Date of birth | 27 May 1953 |
| Plan | SILVER HMO |
| Covered from | 28 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001734 | 2 Mar 2025 | 321.00 | CASCADE CARE | Not denied | — |
| CLM0001735 | 26 Feb 2025 | 681.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 243.85 |
| CLM0001736 | 15 Jan 2025 | 187.00 | CASCADE CARE | Not denied | — |