AMARA EVANS
Subscriber on policy B01M000029
Claims
3
Attributed to this person
Charged
1,088.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | AMARA EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000029 |
| Date of birth | 22 May 1981 |
| Plan | BRONZE EPO |
| Covered from | 5 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000114 | 16 Jun 2026 | 110.00 | CASCADE CARE | Not denied | — |
| CLM0000113 | 26 Jan 2026 | 152.00 | CASCADE CARE | Not denied | — |
| CLM0000112 | 20 Feb 2025 | 826.00 | CASCADE CARE | Not denied | — |