SOFIA EVANS
Subscriber on policy B09M000096
Claims
2
Attributed to this person
Charged
947.00
Total submitted
Denied
242.00
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 | Subscriber |
| Policy | B09M000096 |
| Date of birth | 22 Mar 1977 |
| Plan | BRONZE EPO |
| Covered from | 4 Jan 2024 |
| Covered to | 23 Mar 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 |
|---|---|---|---|---|---|
| CLM0000395 | 10 May 2024 | 242.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 242.00 |
| CLM0000396 | 25 Jan 2024 | 705.00 | CASCADE CARE | Not denied | — |