BRIAN EVANS
Subscriber on policy B02M000370
Claims
2
Attributed to this person
Charged
1,483.00
Total submitted
Denied
223.22
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 | BRIAN EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000370 |
| Date of birth | 20 Dec 1990 |
| Plan | SILVER HMO |
| Covered from | 7 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 |
|---|---|---|---|---|---|
| CLM0001574 | 4 Jun 2024 | 642.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 223.22 |
| CLM0001575 | 12 Feb 2024 | 841.00 | MERIDIAN HEALTH PLAN | Not denied | — |