OMAR EVANS
Subscriber on policy B06M000157
Claims
1
Attributed to this person
Charged
190.00
Total submitted
Denied
42.75
1 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 | OMAR EVANS |
| Role on the policy | Subscriber |
| Policy | B06M000157 |
| Date of birth | 13 Dec 2002 |
| Plan | GOLD PPO |
| Covered from | 29 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000779 | 10 Mar 2024 | 190.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 42.75 |