DAVID EVANS
Subscriber on policy B06M000491
Claims
1
Attributed to this person
Charged
779.00
Total submitted
Denied
779.00
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 | DAVID EVANS |
| Role on the policy | Subscriber |
| Policy | B06M000491 |
| Date of birth | 16 Jul 1975 |
| Plan | PLATINUM PPO |
| Covered from | 8 Jan 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 |
|---|---|---|---|---|---|
| CLM0002205 | 3 May 2026 | 779.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 779.00 |