ZARA EVANS
Dependent on policy B08M000410
Claims
3
Attributed to this person
Charged
1,132.00
Total submitted
Denied
97.77
1 denied claims
Patient responsibility
28.20
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000410 |
| Date of birth | 31 May 2010 |
| Plan | GOLD PPO |
| Covered from | 1 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 28.20 |
| Total | 28.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001892 | 18 May 2026 | 188.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001891 | 17 Feb 2025 | 337.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 97.77 |
| CLM0001890 | 26 Aug 2024 | 607.00 | NORTHSTAR MUTUAL | Not denied | — |