UMA EVANS
Dependent on policy B02M000452
Claims
3
Attributed to this person
Charged
1,145.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
19.40
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 | UMA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000452 |
| Date of birth | 10 Apr 1993 |
| Plan | GOLD PPO |
| Covered from | 14 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 19.40 |
| Total | 19.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001925 | 25 Jul 2025 | 161.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001923 | 1 Oct 2024 | 887.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001924 | 11 Aug 2024 | 97.00 | MERIDIAN HEALTH PLAN | Not denied | — |