DAVID EVANS
Subscriber on policy B05M000431
Claims
1
Attributed to this person
Charged
878.00
Total submitted
Denied
878.00
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 | B05M000431 |
| Date of birth | 5 May 1983 |
| Plan | BRONZE EPO |
| Covered from | 19 Sep 2024 |
| Covered to | 8 Feb 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 |
|---|---|---|---|---|---|
| CLM0001814 | 19 Sep 2024 | 878.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 878.00 |