ZARA EVANS
Subscriber on policy B01M000495
Claims
3
Attributed to this person
Charged
885.00
Total submitted
Denied
183.00
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 | ZARA EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000495 |
| Date of birth | 31 Oct 1954 |
| Plan | GOLD PPO |
| Covered from | 5 Feb 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 |
|---|---|---|---|---|---|
| CLM0002211 | 8 Apr 2026 | 183.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 183.00 |
| CLM0002210 | 13 Mar 2026 | 280.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002212 | 7 Oct 2025 | 422.00 | NORTHSTAR MUTUAL | Not denied | — |