FIONA CHEN
Subscriber on policy B09M000281
Claims
2
Attributed to this person
Charged
1,039.00
Total submitted
Denied
857.00
2 denied claims
Patient responsibility
118.30
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 | FIONA CHEN |
| Role on the policy | Subscriber |
| Policy | B09M000281 |
| Date of birth | 5 Jul 2000 |
| Plan | GOLD PPO |
| Covered from | 24 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 118.30 |
| Total | 118.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001153 | 3 Jun 2026 | 182.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001151 | 31 Mar 2026 | 857.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 857.00 |