TOMAS EVANS
Dependent on policy B08M000539
Claims
3
Attributed to this person
Charged
939.00
Total submitted
Denied
267.00
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000539 |
| Date of birth | 14 May 1956 |
| Plan | BRONZE EPO |
| Covered from | 21 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002473 | 2 Aug 2026 | 537.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002474 | 27 Jun 2026 | 135.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002475 | 14 Jul 2025 | 267.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 267.00 |