LEILA EVANS
Dependent on policy B08M000002
Claims
2
Attributed to this person
Charged
423.00
Total submitted
Denied
155.71
2 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 | LEILA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000002 |
| Date of birth | 28 Nov 2006 |
| Plan | BRONZE EPO |
| Covered from | 15 Dec 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 |
|---|---|---|---|---|---|
| CLM0000022 | 31 Jan 2025 | 138.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 138.00 |
| CLM0000023 | 24 Jan 2025 | 285.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 17.71 |