ZARA CHEN
Subscriber on policy B06M000437
Claims
2
Attributed to this person
Charged
868.00
Total submitted
Denied
502.00
1 denied claims
Patient responsibility
25.00
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 CHEN |
| Role on the policy | Subscriber |
| Policy | B06M000437 |
| Date of birth | 20 Mar 1979 |
| Plan | PLATINUM PPO |
| Covered from | 2 Oct 2024 |
| Covered to | 17 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002009 | 15 Nov 2024 | 366.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002010 | 1 Oct 2024 | 502.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 502.00 |