HENRY EVANS
Dependent on policy B10M000480
Claims
1
Attributed to this person
Charged
341.00
Total submitted
Denied
116.92
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 | Dependent · relationship 01 |
| Policy | B10M000480 |
| Date of birth | 25 Jan 1968 |
| Plan | GOLD PPO |
| Covered from | 12 Jan 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0001991 | 20 Sep 2025 | 341.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 116.92 |