GRACE EVANS
Dependent on policy B05M000512
Claims
3
Attributed to this person
Charged
1,705.00
Total submitted
Denied
839.00
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 | GRACE EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000512 |
| Date of birth | 9 Aug 1972 |
| Plan | BRONZE EPO |
| Covered from | 13 Nov 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 |
|---|---|---|---|---|---|
| CLM0002196 | 21 Jul 2026 | 584.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002197 | 20 Jun 2025 | 282.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002198 | 29 May 2025 | 839.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 839.00 |