GRACE CHEN
Dependent on policy B09M000371
Claims
3
Attributed to this person
Charged
1,476.00
Total submitted
Denied
486.00
1 denied claims
Patient responsibility
35.40
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 | GRACE CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000371 |
| Date of birth | 18 Aug 2023 |
| Plan | PLATINUM PPO |
| Covered from | 30 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 35.40 |
| Total | 35.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001536 | 11 Nov 2025 | 177.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001535 | 27 Sep 2025 | 813.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001537 | 21 Mar 2025 | 486.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 486.00 |