DAVID EVANS
Subscriber on policy B01M000269
Claims
1
Attributed to this person
Charged
413.00
Total submitted
Denied
413.00
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 | DAVID EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000269 |
| Date of birth | 10 Jul 1969 |
| Plan | GOLD PPO |
| Covered from | 14 Apr 2024 |
| Covered to | 29 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001151 | 6 May 2024 | 413.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 413.00 |