BRIAN EVANS
Dependent on policy B08M000192
Claims
1
Attributed to this person
Charged
208.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
41.60
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 | BRIAN EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000192 |
| Date of birth | 4 Sep 2011 |
| Plan | BRONZE EPO |
| Covered from | 25 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 41.60 |
| Total | 41.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000851 | 11 Apr 2026 | 208.00 | NORTHSTAR MUTUAL | Not denied | — |