GRACE EVANS
Dependent on policy B04M000609
Claims
1
Attributed to this person
Charged
823.00
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 | GRACE EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000609 |
| Date of birth | 9 Aug 1994 |
| Plan | BRONZE EPO |
| Covered from | 11 Feb 2025 |
| Covered to | 17 May 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002667 | 2 Mar 2025 | 823.00 | NORTHSTAR MUTUAL | Not denied | — |