SOFIA EVANS
Subscriber on policy B09M000759
Claims
3
Attributed to this person
Charged
1,461.00
Total submitted
Denied
109.00
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 | B09M000759 |
| Date of birth | 28 Mar 1969 |
| Plan | SILVER HMO |
| Covered from | 10 Dec 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 |
|---|---|---|---|---|---|
| CLM0003209 | 5 May 2026 | 690.00 | CASCADE CARE | Not denied | — |
| CLM0003211 | 17 Feb 2025 | 662.00 | CASCADE CARE | Not denied | — |
| CLM0003210 | 19 Dec 2024 | 109.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 109.00 |