DAVID EVANS
Dependent on policy B08M000142
Claims
3
Attributed to this person
Charged
959.00
Total submitted
Denied
959.00
3 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 | Dependent · relationship 01 |
| Policy | B08M000142 |
| Date of birth | 27 Nov 1973 |
| Plan | SILVER HMO |
| Covered from | 14 Jan 2025 |
| Covered to | 8 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000648 | 12 Nov 2025 | 405.00 | CASCADE CARE | CARC 18 · DUPLICATE | 405.00 |
| CLM0000650 | 5 Aug 2025 | 328.00 | CASCADE CARE | CARC 11 · CODING | 328.00 |
| CLM0000649 | 2 Jan 2025 | 226.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 226.00 |