ZARA EVANS
Dependent on policy B09M000519
Claims
1
Attributed to this person
Charged
335.00
Total submitted
Denied
335.00
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000519 |
| Date of birth | 18 Aug 2020 |
| Plan | PLATINUM PPO |
| Covered from | 30 Dec 2024 |
| Covered to | 31 May 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002204 | 15 Feb 2025 | 335.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 335.00 |