DAVID EVANS
Subscriber on policy B04M000759
Claims
1
Attributed to this person
Charged
646.00
Total submitted
Denied
646.00
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 | B04M000759 |
| Date of birth | 11 Aug 1978 |
| Plan | SILVER HMO |
| Covered from | 6 Feb 2024 |
| Covered to | 28 Jul 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 |
|---|---|---|---|---|---|
| CLM0003308 | 25 Sep 2024 | 646.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 646.00 |