RAVI EVANS
Subscriber on policy B09M000669
Claims
3
Attributed to this person
Charged
2,133.00
Total submitted
Denied
841.00
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 | RAVI EVANS |
| Role on the policy | Subscriber |
| Policy | B09M000669 |
| Date of birth | 16 Jan 1966 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002837 | 12 Aug 2025 | 573.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002838 | 21 Oct 2024 | 841.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 841.00 |
| CLM0002836 | 19 Aug 2024 | 719.00 | NORTHSTAR MUTUAL | Not denied | — |