DAVID EVANS
Subscriber on policy B01M000225
Claims
2
Attributed to this person
Charged
672.00
Total submitted
Denied
76.00
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 | Subscriber |
| Policy | B01M000225 |
| Date of birth | 7 Oct 1992 |
| Plan | PLATINUM PPO |
| Covered from | 5 Apr 2025 |
| Covered to | 23 Sep 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 |
|---|---|---|---|---|---|
| CLM0000954 | 6 Oct 2025 | 76.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 76.00 |
| CLM0000953 | 2 Sep 2025 | 596.00 | NORTHSTAR MUTUAL | Not denied | — |