LEILA CHEN
Subscriber on policy B01M000663
Claims
1
Attributed to this person
Charged
657.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
427.05
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 | LEILA CHEN |
| Role on the policy | Subscriber |
| Policy | B01M000663 |
| Date of birth | 5 Nov 1954 |
| Plan | BRONZE EPO |
| Covered from | 13 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 427.05 |
| Total | 427.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002971 | 1 Jul 2025 | 657.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |