FIONA EVANS
Subscriber on policy B06M000326
Claims
1
Attributed to this person
Charged
64.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
9.60
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 | FIONA EVANS |
| Role on the policy | Subscriber |
| Policy | B06M000326 |
| Date of birth | 14 Mar 1960 |
| Plan | BRONZE EPO |
| Covered from | 31 Aug 2024 |
| Covered to | 4 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 9.60 |
| Total | 9.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001489 | 5 Aug 2024 | 64.00 | MERIDIAN HEALTH PLAN | Not denied | — |