AMARA EVANS
Dependent on policy B10M000827
Claims
3
Attributed to this person
Charged
1,451.00
Total submitted
Denied
349.00
1 denied claims
Patient responsibility
15.00
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 | AMARA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000827 |
| Date of birth | 31 Dec 1992 |
| Plan | BRONZE EPO |
| Covered from | 27 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003504 | 15 Apr 2026 | 349.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 349.00 |
| CLM0003505 | 5 Oct 2024 | 658.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003503 | 25 Sep 2024 | 444.00 | MERIDIAN HEALTH PLAN | Not denied | — |