BRIAN EVANS
Subscriber on policy B04M000151
Claims
3
Attributed to this person
Charged
1,430.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
321.10
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 | Subscriber |
| Policy | B04M000151 |
| Date of birth | 1 Nov 1968 |
| Plan | BRONZE EPO |
| Covered from | 5 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 321.10 |
| Total | 321.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000696 | 14 Mar 2026 | 759.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000694 | 14 Oct 2025 | 494.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0000695 | 28 Dec 2024 | 177.00 | MERIDIAN HEALTH PLAN | Not denied | — |