LEILA EVANS
Subscriber on policy B04M000264
Claims
2
Attributed to this person
Charged
556.00
Total submitted
Denied
440.00
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 | LEILA EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000264 |
| Date of birth | 4 Feb 2003 |
| Plan | SILVER HMO |
| Covered from | 3 May 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0001144 | 30 Nov 2024 | 440.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 440.00 |
| CLM0001145 | 28 Jun 2024 | 116.00 | NORTHSTAR MUTUAL | Not denied | — |