WENDY EVANS
Dependent on policy B10M000167
Claims
2
Attributed to this person
Charged
999.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
107.60
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 | Dependent · relationship 19 |
| Policy | B10M000167 |
| Date of birth | 9 Feb 2023 |
| Plan | SILVER HMO |
| Covered from | 25 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 107.60 |
| Total | 107.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000706 | 16 May 2026 | 538.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000707 | 15 Jan 2025 | 461.00 | NORTHSTAR MUTUAL | Not denied | — |