ELENA WILSON
Subscriber on policy B05M000035
Claims
3
Attributed to this person
Charged
1,734.00
Total submitted
Denied
546.00
1 denied claims
Patient responsibility
128.00
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 | ELENA WILSON |
| Role on the policy | Subscriber |
| Policy | B05M000035 |
| Date of birth | 14 Apr 1958 |
| Plan | SILVER HMO |
| Covered from | 25 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 128.00 |
| Total | 128.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000162 | 17 Jul 2026 | 640.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000164 | 19 Apr 2025 | 548.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000163 | 10 Feb 2025 | 546.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 546.00 |