TOMAS CHEN
Subscriber on policy B07M000191
Claims
2
Attributed to this person
Charged
936.00
Total submitted
Denied
936.00
2 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 | TOMAS CHEN |
| Role on the policy | Subscriber |
| Policy | B07M000191 |
| Date of birth | 7 Aug 2000 |
| Plan | GOLD PPO |
| Covered from | 13 Dec 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000795 | 8 Jul 2025 | 346.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 346.00 |
| CLM0000794 | 10 Dec 2024 | 590.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 590.00 |