LEILA WILSON
Subscriber on policy B06M000218
Claims
2
Attributed to this person
Charged
845.00
Total submitted
Denied
320.00
1 denied claims
Patient responsibility
105.00
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 | LEILA WILSON |
| Role on the policy | Subscriber |
| Policy | B06M000218 |
| Date of birth | 17 Apr 1968 |
| Plan | BRONZE EPO |
| Covered from | 17 Nov 2024 |
| Covered to | 17 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 105.00 |
| Total | 105.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001042 | 2 Aug 2025 | 320.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 320.00 |
| CLM0001043 | 26 Jun 2025 | 525.00 | MERIDIAN HEALTH PLAN | Not denied | — |