OMAR EVANS
Dependent on policy B08M000628
Claims
3
Attributed to this person
Charged
1,252.00
Total submitted
Denied
0.00
0 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 | OMAR EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000628 |
| Date of birth | 5 Aug 1992 |
| Plan | PLATINUM PPO |
| Covered from | 25 Mar 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 |
|---|---|---|---|---|---|
| CLM0002857 | 4 Jun 2026 | 403.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002859 | 30 Jun 2025 | 111.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002858 | 28 May 2025 | 738.00 | NORTHSTAR MUTUAL | Not denied | — |