CARLA EVANS
Subscriber on policy B04M000364
Claims
2
Attributed to this person
Charged
811.00
Total submitted
Denied
174.63
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 | CARLA EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000364 |
| Date of birth | 23 Dec 1968 |
| Plan | PLATINUM PPO |
| Covered from | 22 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 |
|---|---|---|---|---|---|
| CLM0001563 | 16 Apr 2026 | 142.00 | CASCADE CARE | Not denied | — |
| CLM0001562 | 3 Jul 2025 | 669.00 | CASCADE CARE | CARC 11 · CODING | 174.63 |