YUSUF EVANS
Subscriber on policy B01M000202
Claims
2
Attributed to this person
Charged
1,292.00
Total submitted
Denied
597.00
2 denied claims
Patient responsibility
451.75
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 | YUSUF EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000202 |
| Date of birth | 26 Sep 1992 |
| Plan | GOLD PPO |
| Covered from | 22 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 451.75 |
| Total | 451.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000860 | 5 Aug 2025 | 597.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 597.00 |
| CLM0000861 | 5 Oct 2024 | 695.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |