DAVID CHEN
Subscriber on policy B09M000371
Claims
2
Attributed to this person
Charged
642.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
36.75
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 | Subscriber |
| Policy | B09M000371 |
| Date of birth | 28 Aug 2003 |
| Plan | PLATINUM PPO |
| Covered from | 30 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 36.75 |
| Total | 36.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001530 | 25 Jul 2026 | 397.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001529 | 25 Jun 2026 | 245.00 | NORTHSTAR MUTUAL | Not denied | — |