TOMAS WILSON
Subscriber on policy B04M000694
Claims
3
Attributed to this person
Charged
1,006.00
Total submitted
Denied
555.00
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 | TOMAS WILSON |
| Role on the policy | Subscriber |
| Policy | B04M000694 |
| Date of birth | 18 Oct 1993 |
| Plan | BRONZE EPO |
| Covered from | 18 Oct 2024 |
| Covered to | 28 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003023 | 26 Jan 2025 | 555.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 555.00 |
| CLM0003022 | 8 Dec 2024 | 189.00 | CASCADE CARE | Not denied | — |
| CLM0003024 | 25 Oct 2024 | 262.00 | CASCADE CARE | Not denied | — |