SOFIA EVANS
Subscriber on policy B04M000369
Claims
1
Attributed to this person
Charged
242.00
Total submitted
Denied
242.00
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 | SOFIA EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000369 |
| Date of birth | 11 Jan 1950 |
| Plan | SILVER HMO |
| Covered from | 1 Dec 2024 |
| Covered to | 13 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001576 | 7 Jun 2025 | 242.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 242.00 |