IVAN EVANS
Subscriber on policy B01M000522
Claims
3
Attributed to this person
Charged
1,746.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | IVAN EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000522 |
| Date of birth | 4 Apr 1976 |
| Plan | SILVER HMO |
| Covered from | 24 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002350 | 14 Sep 2025 | 503.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002351 | 4 Sep 2025 | 555.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002349 | 28 Jun 2025 | 688.00 | MERIDIAN HEALTH PLAN | Not denied | — |