HENRY EVANS
Dependent on policy B05M000387
Claims
1
Attributed to this person
Charged
721.00
Total submitted
Denied
721.00
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 | HENRY EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000387 |
| Date of birth | 12 Sep 2015 |
| Plan | BRONZE EPO |
| Covered from | 28 Apr 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 |
|---|---|---|---|---|---|
| CLM0001643 | 7 Jun 2025 | 721.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 721.00 |