TOMAS WILSON
Subscriber on policy B01M000448
Claims
1
Attributed to this person
Charged
828.00
Total submitted
Denied
0.00
0 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 | TOMAS WILSON |
| Role on the policy | Subscriber |
| Policy | B01M000448 |
| Date of birth | 15 Jul 1974 |
| Plan | BRONZE EPO |
| Covered from | 8 Aug 2024 |
| Covered to | 8 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001999 | 8 Oct 2024 | 828.00 | NORTHSTAR MUTUAL | Not denied | — |