OMAR EVANS
Dependent on policy B05M000898
Claims
2
Attributed to this person
Charged
950.00
Total submitted
Denied
32.78
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 | OMAR EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000898 |
| Date of birth | 14 Jul 1985 |
| Plan | GOLD PPO |
| Covered from | 17 Nov 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 |
|---|---|---|---|---|---|
| CLM0003828 | 11 May 2025 | 852.00 | CASCADE CARE | Not denied | — |
| CLM0003827 | 17 Jan 2025 | 98.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 32.78 |