CARLA EVANS
Dependent on policy B06M000480
Claims
1
Attributed to this person
Charged
591.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
118.20
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 | CARLA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000480 |
| Date of birth | 18 Dec 1978 |
| 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 | 118.20 |
| Total | 118.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002168 | 7 Nov 2025 | 591.00 | CASCADE CARE | Not denied | — |