YUSUF EVANS
Subscriber on policy B06M000824
Claims
1
Attributed to this person
Charged
482.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
313.30
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 | Subscriber |
| Policy | B06M000824 |
| Date of birth | 22 Oct 1973 |
| Plan | PLATINUM PPO |
| Covered from | 15 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 313.30 |
| Total | 313.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003607 | 21 Nov 2025 | 482.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |