TOMAS EVANS
Dependent on policy B05M000529
Claims
3
Attributed to this person
Charged
387.00
Total submitted
Denied
156.00
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000529 |
| Date of birth | 17 Sep 1975 |
| Plan | SILVER HMO |
| Covered from | 5 Sep 2024 |
| Covered to | 17 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002259 | 11 Nov 2024 | 109.00 | CASCADE CARE | Not denied | — |
| CLM0002260 | 28 Aug 2024 | 122.00 | CASCADE CARE | Not denied | — |
| CLM0002258 | 14 Aug 2024 | 156.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 156.00 |