DAVID EVANS
Dependent on policy B02M000406
Claims
2
Attributed to this person
Charged
628.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
56.40
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 | DAVID EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000406 |
| Date of birth | 4 Feb 2021 |
| Plan | SILVER HMO |
| Covered from | 26 Nov 2024 |
| Covered to | 24 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 56.40 |
| Total | 56.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001749 | 3 May 2025 | 252.00 | CASCADE CARE | Not denied | — |
| CLM0001748 | 1 May 2025 | 376.00 | CASCADE CARE | Not denied | — |