GRACE EVANS
Dependent on policy B02M000149
Claims
2
Attributed to this person
Charged
731.00
Total submitted
Denied
72.12
1 denied claims
Patient responsibility
73.20
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 | GRACE EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000149 |
| Date of birth | 29 May 2011 |
| Plan | PLATINUM PPO |
| Covered from | 17 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 73.20 |
| Total | 73.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000681 | 20 Apr 2026 | 488.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000680 | 10 Jul 2025 | 243.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 72.12 |