ELENA CHEN
Dependent on policy B08M000195
Claims
1
Attributed to this person
Charged
441.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
66.15
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 | ELENA CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000195 |
| Date of birth | 4 Aug 1984 |
| Plan | BRONZE EPO |
| Covered from | 6 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 66.15 |
| Total | 66.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000869 | 6 Sep 2024 | 441.00 | NORTHSTAR MUTUAL | Not denied | — |