BRIAN WILSON
Subscriber on policy B05M000625
Claims
2
Attributed to this person
Charged
764.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
37.20
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 | BRIAN WILSON |
| Role on the policy | Subscriber |
| Policy | B05M000625 |
| Date of birth | 6 Jul 1975 |
| Plan | SILVER HMO |
| Covered from | 21 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 37.20 |
| Total | 37.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002693 | 29 Apr 2025 | 516.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002694 | 16 Jan 2025 | 248.00 | MERIDIAN HEALTH PLAN | Not denied | — |