DAVID CHEN
Subscriber on policy B07M000838
Claims
3
Attributed to this person
Charged
2,069.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
555.75
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 | DAVID CHEN |
| Role on the policy | Subscriber |
| Policy | B07M000838 |
| Date of birth | 17 Jun 1955 |
| Plan | SILVER HMO |
| Covered from | 7 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 555.75 |
| Total | 555.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003450 | 20 Mar 2026 | 855.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003448 | 8 Jan 2026 | 351.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003449 | 4 Dec 2024 | 863.00 | NORTHSTAR MUTUAL | Not denied | — |