LEILA EVANS
Dependent on policy B01M000800
Claims
3
Attributed to this person
Charged
1,599.00
Total submitted
Denied
404.00
1 denied claims
Patient responsibility
20.00
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 | LEILA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000800 |
| Date of birth | 14 Mar 1972 |
| Plan | GOLD PPO |
| Covered from | 26 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003560 | 1 Oct 2025 | 404.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 404.00 |
| CLM0003562 | 28 Feb 2025 | 680.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003561 | 28 Jan 2025 | 515.00 | MERIDIAN HEALTH PLAN | Not denied | — |