SOFIA EVANS
Dependent on policy B03M000829
Claims
3
Attributed to this person
Charged
1,728.00
Total submitted
Denied
876.00
2 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 | SOFIA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000829 |
| Date of birth | 4 Feb 1990 |
| 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 |
|---|---|---|---|---|---|
| CLM0003574 | 31 May 2025 | 119.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 119.00 |
| CLM0003576 | 5 Apr 2025 | 852.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003575 | 22 Dec 2024 | 757.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 757.00 |