KEVIN WILSON
Subscriber on policy B05M000336
Claims
1
Attributed to this person
Charged
369.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
239.85
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 | KEVIN WILSON |
| Role on the policy | Subscriber |
| Policy | B05M000336 |
| Date of birth | 15 Apr 1975 |
| Plan | BRONZE EPO |
| Covered from | 23 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 239.85 |
| Total | 239.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001428 | 26 Sep 2025 | 369.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |