KEVIN EVANS
Subscriber on policy B02M000447
Claims
3
Attributed to this person
Charged
1,629.00
Total submitted
Denied
64.00
1 denied claims
Patient responsibility
100.65
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 | B02M000447 |
| Date of birth | 7 Aug 1968 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jun 2025 |
| Covered to | 21 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 100.65 |
| Total | 100.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001901 | 14 Nov 2025 | 64.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 64.00 |
| CLM0001902 | 11 Sep 2025 | 671.00 | CASCADE CARE | Not denied | — |
| CLM0001903 | 25 Jun 2025 | 894.00 | CASCADE CARE | Not denied | — |