KEVIN EVANS
Subscriber on policy B04M000693
Claims
1
Attributed to this person
Charged
116.00
Total submitted
Denied
40.87
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 | KEVIN EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000693 |
| Date of birth | 30 Apr 1964 |
| Plan | GOLD PPO |
| Covered from | 2 Jun 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 |
|---|---|---|---|---|---|
| CLM0003017 | 20 Feb 2026 | 116.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 40.87 |