JULIA EVANS
Dependent on policy B09M000514
Claims
2
Attributed to this person
Charged
758.00
Total submitted
Denied
421.00
1 denied claims
Patient responsibility
67.40
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 | JULIA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000514 |
| Date of birth | 24 Mar 2020 |
| Plan | GOLD PPO |
| Covered from | 28 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 67.40 |
| Total | 67.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002176 | 17 Mar 2026 | 337.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002177 | 7 Nov 2025 | 421.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 421.00 |