DAVID CHEN
Dependent on policy B01M000011
Claims
2
Attributed to this person
Charged
380.00
Total submitted
Denied
99.15
1 denied claims
Patient responsibility
14.40
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 | Dependent · relationship 01 |
| Policy | B01M000011 |
| Date of birth | 21 Oct 1977 |
| Plan | BRONZE EPO |
| Covered from | 29 Mar 2025 |
| Covered to | 27 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 14.40 |
| Total | 14.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000037 | 23 Oct 2025 | 284.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 99.15 |
| CLM0000038 | 31 Aug 2025 | 96.00 | CASCADE CARE | Not denied | — |