CARLA EVANS
Dependent on policy B01M000495
Claims
3
Attributed to this person
Charged
1,325.00
Total submitted
Denied
714.00
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 | CARLA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000495 |
| Date of birth | 14 Nov 1989 |
| 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 |
|---|---|---|---|---|---|
| CLM0002218 | 18 Jun 2026 | 195.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002216 | 19 May 2026 | 714.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 714.00 |
| CLM0002217 | 7 Mar 2026 | 416.00 | NORTHSTAR MUTUAL | Not denied | — |