ELENA EVANS
Dependent on policy B07M000881
Claims
2
Attributed to this person
Charged
944.00
Total submitted
Denied
534.00
1 denied claims
Patient responsibility
82.00
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 | ELENA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000881 |
| Date of birth | 25 Sep 1981 |
| Plan | PLATINUM PPO |
| Covered from | 12 Sep 2024 |
| Covered to | 29 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 82.00 |
| Total | 82.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003648 | 14 Nov 2024 | 410.00 | CASCADE CARE | Not denied | — |
| CLM0003649 | 4 Oct 2024 | 534.00 | CASCADE CARE | CARC 11 · CODING | 534.00 |