PRIYA WILSON
Subscriber on policy B05M000543
Claims
1
Attributed to this person
Charged
686.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
137.20
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 | PRIYA WILSON |
| Role on the policy | Subscriber |
| Policy | B05M000543 |
| Date of birth | 12 Jun 1951 |
| Plan | GOLD PPO |
| Covered from | 13 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 137.20 |
| Total | 137.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002321 | 21 Sep 2025 | 686.00 | CASCADE CARE | Not denied | — |