AMARA EVANS
Subscriber on policy B01M000268
Claims
3
Attributed to this person
Charged
1,030.00
Total submitted
Denied
472.00
1 denied claims
Patient responsibility
32.55
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 | AMARA EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000268 |
| Date of birth | 25 May 1965 |
| Plan | SILVER HMO |
| Covered from | 13 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 32.55 |
| Total | 32.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001142 | 28 Jun 2026 | 472.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 472.00 |
| CLM0001143 | 20 Jan 2026 | 217.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001141 | 12 Oct 2024 | 341.00 | NORTHSTAR MUTUAL | Not denied | — |