BRIAN EVANS
Dependent on policy B08M000048
Claims
1
Attributed to this person
Charged
767.00
Total submitted
Denied
767.00
1 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 | BRIAN EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000048 |
| Date of birth | 3 Jan 2018 |
| Plan | BRONZE EPO |
| Covered from | 13 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000206 | 19 Aug 2026 | 767.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 767.00 |