WENDY EVANS
Subscriber on policy B10M000450
Claims
3
Attributed to this person
Charged
1,131.00
Total submitted
Denied
129.76
1 denied claims
Patient responsibility
30.00
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 | WENDY EVANS |
| Role on the policy | Subscriber |
| Policy | B10M000450 |
| Date of birth | 9 May 1973 |
| Plan | PLATINUM PPO |
| Covered from | 16 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001863 | 29 Jun 2026 | 324.00 | CASCADE CARE | Not denied | — |
| CLM0001861 | 29 Nov 2025 | 450.00 | CASCADE CARE | Not denied | — |
| CLM0001862 | 9 Oct 2024 | 357.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 129.76 |