ELENA CHEN
Dependent on policy B06M000152
Claims
3
Attributed to this person
Charged
2,554.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
559.00
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 CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000152 |
| Date of birth | 8 Sep 1988 |
| Plan | GOLD PPO |
| Covered from | 18 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 559.00 |
| Total | 559.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000754 | 13 Aug 2025 | 831.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000756 | 20 Jul 2025 | 860.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000755 | 7 Jul 2025 | 863.00 | NORTHSTAR MUTUAL | Not denied | — |