YUSUF EVANS
Dependent on policy B06M000157
Claims
2
Attributed to this person
Charged
820.00
Total submitted
Denied
81.00
1 denied claims
Patient responsibility
110.85
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 | YUSUF EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000157 |
| Date of birth | 8 Jul 2012 |
| Plan | GOLD PPO |
| Covered from | 29 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 110.85 |
| Total | 110.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000781 | 24 Sep 2024 | 739.00 | CASCADE CARE | Not denied | — |
| CLM0000780 | 31 Mar 2024 | 81.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 81.00 |