VICTOR EVANS
Dependent on policy B03M000401
Claims
2
Attributed to this person
Charged
394.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
9.00
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 | VICTOR EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000401 |
| Date of birth | 8 Jun 2021 |
| Plan | SILVER HMO |
| Covered from | 10 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 9.00 |
| Total | 9.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001636 | 15 Jan 2026 | 60.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001635 | 17 Sep 2025 | 334.00 | MERIDIAN HEALTH PLAN | Not denied | — |