KEVIN EVANS
Subscriber on policy B02M000045
Claims
1
Attributed to this person
Charged
202.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.30
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 | KEVIN EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000045 |
| Date of birth | 11 Jun 2003 |
| Plan | GOLD PPO |
| Covered from | 16 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 30.30 |
| Total | 30.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000217 | 4 Nov 2025 | 202.00 | CASCADE CARE | Not denied | — |