ELENA EVANS
Dependent on policy B10M000165
Claims
3
Attributed to this person
Charged
2,206.00
Total submitted
Denied
222.54
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 | ELENA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000165 |
| Date of birth | 13 Jun 2002 |
| Plan | GOLD PPO |
| Covered from | 26 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000694 | 9 May 2026 | 691.00 | CASCADE CARE | Not denied | — |
| CLM0000693 | 22 Jan 2026 | 641.00 | CASCADE CARE | CARC 11 · CODING | 222.54 |
| CLM0000692 | 27 Aug 2025 | 874.00 | CASCADE CARE | Not denied | — |