HENRY EVANS
Subscriber on policy B10M000065
Claims
1
Attributed to this person
Charged
405.00
Total submitted
Denied
405.00
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 | HENRY EVANS |
| Role on the policy | Subscriber |
| Policy | B10M000065 |
| Date of birth | 21 Feb 1952 |
| Plan | BRONZE EPO |
| Covered from | 22 Feb 2025 |
| Covered to | 5 Nov 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000258 | 18 Jun 2025 | 405.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 405.00 |