ZARA EVANS
Dependent on policy B02M000406
Claims
2
Attributed to this person
Charged
900.00
Total submitted
Denied
691.00
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000406 |
| Date of birth | 2 Jan 2004 |
| 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 |
|---|---|---|---|---|---|
| CLM0001747 | 12 May 2025 | 209.00 | CASCADE CARE | Not denied | — |
| CLM0001746 | 11 Jan 2025 | 691.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 691.00 |