FIONA EVANS
Dependent on policy B06M000480
Claims
3
Attributed to this person
Charged
334.00
Total submitted
Denied
199.00
2 denied claims
Patient responsibility
27.00
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 | FIONA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000480 |
| Date of birth | 25 Mar 1949 |
| Plan | BRONZE EPO |
| Covered from | 7 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 27.00 |
| Total | 27.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002164 | 23 May 2026 | 135.00 | CASCADE CARE | Not denied | — |
| CLM0002162 | 20 Apr 2025 | 106.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 106.00 |
| CLM0002163 | 28 Feb 2025 | 93.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 93.00 |