MARCUS EVANS
Dependent on policy B01M000484
Claims
3
Attributed to this person
Charged
1,455.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
176.40
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 | MARCUS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000484 |
| Date of birth | 28 May 2004 |
| Plan | SILVER HMO |
| Covered from | 2 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 176.40 |
| Total | 176.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002157 | 23 Aug 2026 | 257.00 | CASCADE CARE | Not denied | — |
| CLM0002158 | 20 May 2026 | 882.00 | CASCADE CARE | Not denied | — |
| CLM0002159 | 22 Nov 2024 | 316.00 | CASCADE CARE | Not denied | — |