TOMAS EVANS
Dependent on policy B10M000379
Claims
3
Attributed to this person
Charged
1,155.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
96.30
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000379 |
| Date of birth | 28 Aug 1967 |
| Plan | BRONZE EPO |
| Covered from | 21 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 96.30 |
| Total | 96.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001576 | 29 Jun 2026 | 642.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001575 | 2 Jul 2025 | 288.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001574 | 21 Dec 2024 | 225.00 | MERIDIAN HEALTH PLAN | Not denied | — |