DAVID EVANS
Subscriber on policy B04M000840
Claims
1
Attributed to this person
Charged
262.00
Total submitted
Denied
262.00
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 | DAVID EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000840 |
| Date of birth | 27 Mar 1973 |
| Plan | PLATINUM PPO |
| Covered from | 17 Dec 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 |
|---|---|---|---|---|---|
| CLM0003629 | 2 Jul 2026 | 262.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 262.00 |