GRACE EVANS
Dependent on policy B04M000317
Claims
3
Attributed to this person
Charged
2,379.00
Total submitted
Denied
0.00
0 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 | GRACE EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000317 |
| Date of birth | 28 Dec 2013 |
| Plan | BRONZE EPO |
| Covered from | 24 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001390 | 12 Mar 2026 | 751.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001388 | 18 Dec 2025 | 834.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001389 | 14 Oct 2025 | 794.00 | MERIDIAN HEALTH PLAN | Not denied | — |