GRACE EVANS
Subscriber on policy B03M000518
Claims
2
Attributed to this person
Charged
320.00
Total submitted
Denied
0.00
0 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 | GRACE EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000518 |
| Date of birth | 18 Sep 1958 |
| Plan | GOLD PPO |
| Covered from | 23 Jul 2024 |
| Covered to | 25 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002125 | 8 Dec 2024 | 165.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002124 | 13 Jul 2024 | 155.00 | NORTHSTAR MUTUAL | Not denied | — |