DAVID EVANS
Dependent on policy B04M000707
Claims
1
Attributed to this person
Charged
823.00
Total submitted
Denied
369.00
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 | Dependent · relationship 01 |
| Policy | B04M000707 |
| Date of birth | 28 Jul 1958 |
| Plan | PLATINUM PPO |
| Covered from | 11 Apr 2024 |
| Covered to | 24 Oct 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 |
|---|---|---|---|---|---|
| CLM0003079 | 2 Aug 2024 | 823.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 369.00 |