DAVID EVANS
Subscriber on policy B08M000174
Claims
1
Attributed to this person
Charged
362.00
Total submitted
Denied
362.00
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 | DAVID EVANS |
| Role on the policy | Subscriber |
| Policy | B08M000174 |
| Date of birth | 21 Nov 1998 |
| Plan | PLATINUM PPO |
| Covered from | 25 Nov 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 |
|---|---|---|---|---|---|
| CLM0000785 | 28 Aug 2025 | 362.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 362.00 |