UMA EVANS
Dependent on policy B04M000722
Claims
3
Attributed to this person
Charged
551.00
Total submitted
Denied
390.00
2 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 | UMA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000722 |
| Date of birth | 31 Oct 1989 |
| Plan | PLATINUM PPO |
| Covered from | 5 Apr 2024 |
| Covered to | 17 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003142 | 22 Dec 2024 | 171.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 171.00 |
| CLM0003143 | 15 May 2024 | 219.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 219.00 |
| CLM0003144 | 13 May 2024 | 161.00 | MERIDIAN HEALTH PLAN | Not denied | — |