GRACE EVANS
Dependent on policy B05M000469
Claims
1
Attributed to this person
Charged
388.00
Total submitted
Denied
388.00
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 | B05M000469 |
| Date of birth | 28 Jan 1949 |
| Plan | SILVER HMO |
| Covered from | 12 Jul 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 |
|---|---|---|---|---|---|
| CLM0001973 | 26 Dec 2025 | 388.00 | CASCADE CARE | CARC 109 · COB | 388.00 |