BRIAN EVANS
Subscriber on policy B02M000269
Claims
1
Attributed to this person
Charged
439.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
65.85
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 | B02M000269 |
| Date of birth | 31 Jul 1953 |
| Plan | GOLD PPO |
| Covered from | 24 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 65.85 |
| Total | 65.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001175 | 30 Oct 2025 | 439.00 | CASCADE CARE | Not denied | — |