BRIAN EVANS
Dependent on policy B04M000573
Claims
3
Attributed to this person
Charged
776.00
Total submitted
Denied
0.00
0 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 | BRIAN EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000573 |
| Date of birth | 9 Feb 1967 |
| Plan | SILVER HMO |
| Covered from | 16 Jul 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 |
|---|---|---|---|---|---|
| CLM0002510 | 11 Aug 2026 | 227.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002511 | 2 Feb 2025 | 144.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002509 | 21 Oct 2024 | 405.00 | NORTHSTAR MUTUAL | Not denied | — |