CARLA EVANS
Dependent on policy B07M000745
Claims
1
Attributed to this person
Charged
359.00
Total submitted
Denied
359.00
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 | CARLA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000745 |
| Date of birth | 9 Jan 1964 |
| Plan | GOLD PPO |
| Covered from | 4 Feb 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 |
|---|---|---|---|---|---|
| CLM0003074 | 5 Oct 2025 | 359.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 359.00 |