SOFIA EVANS
Dependent on policy B07M000881
Claims
3
Attributed to this person
Charged
1,988.00
Total submitted
Denied
552.00
2 denied claims
Patient responsibility
407.55
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 | SOFIA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000881 |
| Date of birth | 19 Jul 2003 |
| Plan | PLATINUM PPO |
| Covered from | 12 Sep 2024 |
| Covered to | 29 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 407.55 |
| Total | 407.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003653 | 9 Dec 2024 | 627.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003655 | 9 Nov 2024 | 552.00 | CASCADE CARE | CARC 18 · DUPLICATE | 552.00 |
| CLM0003654 | 14 Oct 2024 | 809.00 | CASCADE CARE | Not denied | — |