ELENA EVANS
Subscriber on policy B01M000497
Claims
1
Attributed to this person
Charged
375.00
Total submitted
Denied
375.00
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 | ELENA EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000497 |
| Date of birth | 22 Dec 2000 |
| Plan | BRONZE EPO |
| Covered from | 30 Apr 2025 |
| Covered to | 28 Sep 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 |
|---|---|---|---|---|---|
| CLM0002232 | 5 Jun 2025 | 375.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 375.00 |