BRIAN EVANS
Dependent on policy B03M000858
Claims
3
Attributed to this person
Charged
1,168.00
Total submitted
Denied
146.00
2 denied claims
Patient responsibility
443.30
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 | BRIAN EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000858 |
| Date of birth | 30 Jun 1963 |
| Plan | BRONZE EPO |
| Covered from | 23 Feb 2025 |
| Covered to | 9 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 443.30 |
| Total | 443.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003723 | 6 Oct 2025 | 682.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003724 | 10 Sep 2025 | 340.00 | CASCADE CARE | Not denied | — |
| CLM0003722 | 1 May 2025 | 146.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 146.00 |