DAVID EVANS
Subscriber on policy B04M000087
Claims
3
Attributed to this person
Charged
1,097.00
Total submitted
Denied
185.37
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 | DAVID EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000087 |
| Date of birth | 11 Oct 1979 |
| Plan | GOLD PPO |
| Covered from | 4 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000389 | 23 Mar 2026 | 294.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000388 | 11 Jan 2026 | 302.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000387 | 22 Aug 2025 | 501.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 185.37 |