LEILA EVANS
Subscriber on policy B03M000120
Claims
3
Attributed to this person
Charged
982.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
78.45
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 | B03M000120 |
| Date of birth | 1 Apr 1993 |
| Plan | PLATINUM PPO |
| Covered from | 3 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 78.45 |
| Total | 78.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000469 | 19 Oct 2025 | 384.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000467 | 28 Jul 2025 | 75.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000468 | 13 Jul 2025 | 523.00 | MERIDIAN HEALTH PLAN | Not denied | — |