LEILA EVANS
Subscriber on policy B01M000744
Claims
3
Attributed to this person
Charged
866.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
302.25
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 | LEILA EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000744 |
| Date of birth | 7 Nov 1982 |
| Plan | PLATINUM PPO |
| Covered from | 23 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 302.25 |
| Total | 302.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003301 | 13 Apr 2026 | 465.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003302 | 4 Jul 2025 | 236.00 | CASCADE CARE | Not denied | — |
| CLM0003300 | 26 Dec 2024 | 165.00 | CASCADE CARE | Not denied | — |