GRACE EVANS
Subscriber on policy B01M000092
Claims
2
Attributed to this person
Charged
1,523.00
Total submitted
Denied
1,523.00
2 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 | GRACE EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000092 |
| Date of birth | 14 Jul 1950 |
| Plan | SILVER HMO |
| Covered from | 14 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000361 | 26 Dec 2025 | 686.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 686.00 |
| CLM0000362 | 3 Apr 2025 | 837.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 837.00 |