AMARA EVANS
Dependent on policy B07M000864
Claims
3
Attributed to this person
Charged
903.00
Total submitted
Denied
240.35
3 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 | AMARA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000864 |
| Date of birth | 11 Jun 1993 |
| Plan | SILVER HMO |
| Covered from | 17 Aug 2024 |
| Covered to | 15 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003577 | 1 Oct 2024 | 633.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 130.87 |
| CLM0003576 | 2 Sep 2024 | 149.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 66.57 |
| CLM0003575 | 17 Aug 2024 | 121.00 | CASCADE CARE | CARC 18 · DUPLICATE | 42.91 |