ZARA WILSON
Dependent on policy B04M000694
Claims
1
Attributed to this person
Charged
329.00
Total submitted
Denied
329.00
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 | ZARA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000694 |
| Date of birth | 23 Oct 2020 |
| 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 |
|---|---|---|---|---|---|
| CLM0003027 | 14 Feb 2025 | 329.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 329.00 |