OMAR EVANS
Dependent on policy B01M000805
Claims
2
Attributed to this person
Charged
388.00
Total submitted
Denied
109.36
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 | B01M000805 |
| Date of birth | 18 Apr 2018 |
| Plan | GOLD PPO |
| Covered from | 25 Jul 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 |
|---|---|---|---|---|---|
| CLM0003587 | 19 Feb 2026 | 238.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 109.36 |
| CLM0003586 | 17 Sep 2024 | 150.00 | NORTHSTAR MUTUAL | Not denied | — |