DAVID EVANS
Dependent on policy B04M000419
Claims
2
Attributed to this person
Charged
939.00
Total submitted
Denied
147.00
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 | DAVID EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000419 |
| Date of birth | 6 Feb 2014 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 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 |
|---|---|---|---|---|---|
| CLM0001806 | 27 Jan 2026 | 792.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001805 | 24 Mar 2024 | 147.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 147.00 |