WENDY EVANS
Subscriber on policy B09M000766
Claims
2
Attributed to this person
Charged
1,066.00
Total submitted
Denied
867.00
1 denied claims
Patient responsibility
39.80
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 | WENDY EVANS |
| Role on the policy | Subscriber |
| Policy | B09M000766 |
| Date of birth | 20 Jun 1981 |
| Plan | PLATINUM PPO |
| Covered from | 2 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 39.80 |
| Total | 39.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003239 | 26 Mar 2026 | 867.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 867.00 |
| CLM0003238 | 8 Jul 2025 | 199.00 | NORTHSTAR MUTUAL | Not denied | — |