OMAR EVANS
Subscriber on policy B07M000864
Claims
3
Attributed to this person
Charged
925.00
Total submitted
Denied
188.00
1 denied claims
Patient responsibility
50.00
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 | OMAR EVANS |
| Role on the policy | Subscriber |
| Policy | B07M000864 |
| Date of birth | 28 Apr 1966 |
| Plan | SILVER HMO |
| Covered from | 17 Aug 2024 |
| Covered to | 15 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003572 | 21 Mar 2025 | 187.00 | CASCADE CARE | Not denied | — |
| CLM0003573 | 11 Feb 2025 | 550.00 | CASCADE CARE | Not denied | — |
| CLM0003571 | 25 Sep 2024 | 188.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 188.00 |