ZARA EVANS
Dependent on policy B04M000106
Claims
2
Attributed to this person
Charged
427.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000106 |
| Date of birth | 9 Nov 1986 |
| Plan | BRONZE EPO |
| Covered from | 31 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000496 | 25 Aug 2026 | 115.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000495 | 29 Oct 2024 | 312.00 | MERIDIAN HEALTH PLAN | Not denied | — |