SOFIA EVANS
Dependent on policy B09M000097
Claims
2
Attributed to this person
Charged
956.00
Total submitted
Denied
480.00
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 | SOFIA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000097 |
| Date of birth | 17 Mar 1957 |
| Plan | SILVER HMO |
| Covered from | 6 Oct 2024 |
| Covered to | 17 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000402 | 6 Feb 2025 | 476.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000401 | 2 Jan 2025 | 480.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 480.00 |