YUSUF EVANS
Subscriber on policy B05M000791
Claims
2
Attributed to this person
Charged
1,019.00
Total submitted
Denied
225.01
1 denied claims
Patient responsibility
51.75
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 | YUSUF EVANS |
| Role on the policy | Subscriber |
| Policy | B05M000791 |
| Date of birth | 4 Oct 1986 |
| Plan | SILVER HMO |
| Covered from | 8 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.75 |
| Total | 51.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003353 | 15 Mar 2026 | 345.00 | CASCADE CARE | Not denied | — |
| CLM0003354 | 17 May 2025 | 674.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 225.01 |