AMARA EVANS
Subscriber on policy B03M000657
Claims
2
Attributed to this person
Charged
1,038.00
Total submitted
Denied
74.87
1 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 | AMARA EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000657 |
| Date of birth | 6 Aug 1964 |
| Plan | BRONZE EPO |
| Covered from | 17 Feb 2024 |
| Covered to | 28 Sep 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002731 | 17 Sep 2024 | 709.00 | CASCADE CARE | Not denied | — |
| CLM0002732 | 4 Mar 2024 | 329.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 74.87 |