VICTOR EVANS
Subscriber on policy B03M000829
Claims
1
Attributed to this person
Charged
345.00
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 | VICTOR EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000829 |
| Date of birth | 1 Aug 1956 |
| Plan | PLATINUM PPO |
| Covered from | 18 Jan 2025 |
| Covered to | 16 Apr 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 |
|---|---|---|---|---|---|
| CLM0003570 | 3 Mar 2025 | 345.00 | NORTHSTAR MUTUAL | Not denied | — |