ELENA EVANS
Dependent on policy B07M000265
Claims
1
Attributed to this person
Charged
846.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
169.20
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 | ELENA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000265 |
| Date of birth | 1 Apr 1970 |
| Plan | PLATINUM PPO |
| Covered from | 20 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 169.20 |
| Total | 169.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001136 | 3 May 2026 | 846.00 | MERIDIAN HEALTH PLAN | Not denied | — |