IVAN EVANS
Dependent on policy B06M000529
Claims
2
Attributed to this person
Charged
876.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
102.60
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 | IVAN EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000529 |
| Date of birth | 29 Apr 1988 |
| Plan | PLATINUM PPO |
| Covered from | 9 Jan 2024 |
| Covered to | 17 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 102.60 |
| Total | 102.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002360 | 18 Jul 2024 | 363.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002359 | 20 Apr 2024 | 513.00 | NORTHSTAR MUTUAL | Not denied | — |