ELENA EVANS
Subscriber on policy B04M000199
Claims
1
Attributed to this person
Charged
254.00
Total submitted
Denied
254.00
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 | ELENA EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000199 |
| Date of birth | 28 Dec 1996 |
| Plan | BRONZE EPO |
| Covered from | 23 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000890 | 25 Jul 2025 | 254.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 254.00 |