TOMAS EVANS
Subscriber on policy B02M000732
Claims
3
Attributed to this person
Charged
1,763.00
Total submitted
Denied
751.00
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 | TOMAS EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000732 |
| Date of birth | 23 Oct 1964 |
| Plan | PLATINUM PPO |
| Covered from | 28 Nov 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 |
|---|---|---|---|---|---|
| CLM0003065 | 26 Nov 2025 | 504.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003063 | 20 Sep 2025 | 508.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003064 | 7 Apr 2025 | 751.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 751.00 |