DAVID EVANS
Dependent on policy B07M000101
Claims
3
Attributed to this person
Charged
1,117.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
64.60
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 | DAVID EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000101 |
| Date of birth | 1 May 1981 |
| Plan | SILVER HMO |
| Covered from | 24 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 64.60 |
| Total | 64.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000417 | 30 Jun 2026 | 323.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000418 | 12 Aug 2025 | 123.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000419 | 8 Aug 2025 | 671.00 | MERIDIAN HEALTH PLAN | Not denied | — |