GRACE EVANS
Dependent on policy B07M000639
Claims
3
Attributed to this person
Charged
1,466.00
Total submitted
Denied
962.00
2 denied claims
Patient responsibility
0.00
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 | GRACE EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000639 |
| Date of birth | 10 Nov 1975 |
| Plan | GOLD PPO |
| Covered from | 22 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002676 | 8 May 2026 | 504.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002677 | 16 Jan 2026 | 582.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 582.00 |
| CLM0002678 | 2 Jan 2026 | 380.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 380.00 |