AMARA CHEN
Subscriber on policy B09M000288
Claims
3
Attributed to this person
Charged
1,149.00
Total submitted
Denied
185.00
1 denied claims
Patient responsibility
103.40
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 | AMARA CHEN |
| Role on the policy | Subscriber |
| Policy | B09M000288 |
| Date of birth | 3 Jul 1986 |
| Plan | GOLD PPO |
| Covered from | 5 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 103.40 |
| Total | 103.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001190 | 9 Jun 2026 | 517.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001191 | 8 Dec 2025 | 447.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001189 | 16 Apr 2025 | 185.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 185.00 |