JULIA EVANS
Dependent on policy B03M000236
Claims
1
Attributed to this person
Charged
361.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
54.15
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 | JULIA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000236 |
| Date of birth | 26 Jun 1991 |
| Plan | SILVER HMO |
| Covered from | 31 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 54.15 |
| Total | 54.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000957 | 31 Jul 2025 | 361.00 | NORTHSTAR MUTUAL | Not denied | — |