WENDY EVANS
Subscriber on policy B05M000067
Claims
2
Attributed to this person
Charged
1,379.00
Total submitted
Denied
608.00
1 denied claims
Patient responsibility
154.20
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 | WENDY EVANS |
| Role on the policy | Subscriber |
| Policy | B05M000067 |
| Date of birth | 9 Sep 1964 |
| Plan | GOLD PPO |
| Covered from | 28 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 154.20 |
| Total | 154.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000315 | 28 Mar 2026 | 771.00 | CASCADE CARE | Not denied | — |
| CLM0000316 | 18 Jun 2025 | 608.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 608.00 |