HENRY EVANS
Dependent on policy B04M000609
Claims
3
Attributed to this person
Charged
1,689.00
Total submitted
Denied
377.00
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 | HENRY EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000609 |
| Date of birth | 29 May 2009 |
| 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 |
|---|---|---|---|---|---|
| CLM0002670 | 15 Apr 2025 | 597.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002669 | 21 Feb 2025 | 715.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002668 | 28 Jan 2025 | 377.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 377.00 |