ELENA EVANS
Dependent on policy B08M000763
Claims
1
Attributed to this person
Charged
433.00
Total submitted
Denied
433.00
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 | ELENA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000763 |
| Date of birth | 30 Dec 1965 |
| Plan | SILVER HMO |
| Covered from | 12 Feb 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 |
|---|---|---|---|---|---|
| CLM0003411 | 20 Apr 2026 | 433.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 433.00 |