CARLA CHEN
Subscriber on policy B09M000612
Claims
3
Attributed to this person
Charged
564.00
Total submitted
Denied
344.00
2 denied claims
Patient responsibility
30.00
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 | CARLA CHEN |
| Role on the policy | Subscriber |
| Policy | B09M000612 |
| Date of birth | 9 Mar 1987 |
| Plan | BRONZE EPO |
| Covered from | 8 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002576 | 27 Nov 2024 | 174.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 174.00 |
| CLM0002575 | 23 Aug 2024 | 170.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 170.00 |
| CLM0002577 | 24 Apr 2024 | 220.00 | CASCADE CARE | Not denied | — |