WENDY CHEN
Dependent on policy B07M000191
Claims
3
Attributed to this person
Charged
1,477.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
160.45
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 | WENDY CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000191 |
| Date of birth | 5 Jan 2015 |
| Plan | GOLD PPO |
| Covered from | 13 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 94.80 |
| CARC 96 · Other | 1 | 65.65 |
| Total | 160.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000800 | 31 Jan 2026 | 101.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000801 | 28 Nov 2025 | 744.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000799 | 1 Apr 2025 | 632.00 | NORTHSTAR MUTUAL | Not denied | — |