CARLA EVANS
Dependent on policy B08M000506
Claims
3
Attributed to this person
Charged
1,362.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
392.60
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 | CARLA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000506 |
| Date of birth | 27 Aug 1987 |
| Plan | PLATINUM PPO |
| Covered from | 30 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 392.60 |
| Total | 392.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002323 | 9 Dec 2025 | 446.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002324 | 13 Feb 2025 | 604.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002325 | 20 Jan 2025 | 312.00 | NORTHSTAR MUTUAL | Not denied | — |