OMAR EVANS
Dependent on policy B04M000199
Claims
1
Attributed to this person
Charged
737.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
147.40
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 | OMAR EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000199 |
| Date of birth | 11 Jan 1988 |
| Plan | BRONZE EPO |
| Covered from | 23 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 147.40 |
| Total | 147.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000891 | 7 Mar 2026 | 737.00 | MERIDIAN HEALTH PLAN | Not denied | — |