FIONA EVANS
Dependent on policy B04M000419
Claims
1
Attributed to this person
Charged
391.00
Total submitted
Denied
81.95
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 | FIONA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000419 |
| Date of birth | 9 Nov 2023 |
| 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 |
|---|---|---|---|---|---|
| CLM0001807 | 15 Oct 2025 | 391.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 81.95 |