SOFIA EVANS
Subscriber on policy B05M000196
Claims
2
Attributed to this person
Charged
1,271.00
Total submitted
Denied
216.66
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 | SOFIA EVANS |
| Role on the policy | Subscriber |
| Policy | B05M000196 |
| Date of birth | 3 Jun 1974 |
| Plan | PLATINUM PPO |
| Covered from | 15 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000825 | 13 Jun 2026 | 879.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 216.66 |
| CLM0000826 | 1 May 2026 | 392.00 | NORTHSTAR MUTUAL | Not denied | — |