IVAN EVANS
Dependent on policy B10M000215
Claims
2
Attributed to this person
Charged
804.00
Total submitted
Denied
106.00
1 denied claims
Patient responsibility
139.60
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 | IVAN EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000215 |
| Date of birth | 28 Dec 1958 |
| Plan | PLATINUM PPO |
| Covered from | 24 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 139.60 |
| Total | 139.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000879 | 15 Feb 2026 | 106.00 | CASCADE CARE | CARC 11 · CODING | 106.00 |
| CLM0000880 | 19 May 2025 | 698.00 | CASCADE CARE | Not denied | — |