ELENA EVANS
Dependent on policy B03M000484
Claims
3
Attributed to this person
Charged
1,319.00
Total submitted
Denied
472.00
2 denied claims
Patient responsibility
0.00
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 | ELENA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000484 |
| Date of birth | 20 Dec 1995 |
| Plan | GOLD PPO |
| Covered from | 24 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002016 | 16 Jul 2026 | 847.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002015 | 22 Mar 2026 | 316.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 316.00 |
| CLM0002017 | 29 May 2025 | 156.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 156.00 |