GRACE CHEN
Subscriber on policy B08M000690
Claims
3
Attributed to this person
Charged
961.00
Total submitted
Denied
520.24
3 denied claims
Patient responsibility
204.10
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 | GRACE CHEN |
| Role on the policy | Subscriber |
| Policy | B08M000690 |
| Date of birth | 10 Jul 1996 |
| Plan | BRONZE EPO |
| Covered from | 3 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 204.10 |
| Total | 204.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003115 | 25 Apr 2026 | 448.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 448.00 |
| CLM0003114 | 31 Mar 2025 | 314.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003113 | 6 Nov 2024 | 199.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 72.24 |