LEILA EVANS
Subscriber on policy B02M000406
Claims
3
Attributed to this person
Charged
1,354.00
Total submitted
Denied
717.00
2 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 | LEILA EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000406 |
| Date of birth | 20 Oct 1999 |
| Plan | SILVER HMO |
| Covered from | 26 Nov 2024 |
| Covered to | 24 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001745 | 17 Jan 2025 | 241.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 241.00 |
| CLM0001744 | 9 Jan 2025 | 476.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 476.00 |
| CLM0001743 | 22 Dec 2024 | 637.00 | CASCADE CARE | Not denied | — |