TOMAS EVANS
Dependent on policy B10M000165
Claims
2
Attributed to this person
Charged
964.00
Total submitted
Denied
964.00
2 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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000165 |
| Date of birth | 13 Jul 2014 |
| Plan | GOLD PPO |
| Covered from | 26 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000691 | 29 Apr 2026 | 823.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 823.00 |
| CLM0000690 | 9 Jan 2026 | 141.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 141.00 |