BRIAN EVANS
Dependent on policy B08M000757
Claims
2
Attributed to this person
Charged
959.00
Total submitted
Denied
185.00
1 denied claims
Patient responsibility
116.10
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 01 |
| Policy | B08M000757 |
| Date of birth | 5 Jun 1969 |
| Plan | GOLD PPO |
| Covered from | 5 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 116.10 |
| Total | 116.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003376 | 4 May 2025 | 185.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 185.00 |
| CLM0003377 | 27 Feb 2025 | 774.00 | MERIDIAN HEALTH PLAN | Not denied | — |