AMARA CHEN
Dependent on policy B07M000307
Claims
3
Attributed to this person
Charged
1,790.00
Total submitted
Denied
362.00
1 denied claims
Patient responsibility
85.95
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 | AMARA CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000307 |
| Date of birth | 15 Dec 1982 |
| Plan | SILVER HMO |
| Covered from | 4 Jan 2024 |
| Covered to | 30 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 85.95 |
| Total | 85.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001324 | 2 Aug 2024 | 573.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001322 | 15 Mar 2024 | 855.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001323 | 18 Dec 2023 | 362.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 362.00 |