ELENA CHEN
Subscriber on policy B09M000807
Claims
3
Attributed to this person
Charged
1,306.00
Total submitted
Denied
109.20
1 denied claims
Patient responsibility
35.70
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 | ELENA CHEN |
| Role on the policy | Subscriber |
| Policy | B09M000807 |
| Date of birth | 19 Nov 1993 |
| Plan | SILVER HMO |
| Covered from | 2 Feb 2024 |
| Covered to | 16 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 35.70 |
| Total | 35.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003427 | 1 Mar 2024 | 256.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 109.20 |
| CLM0003425 | 21 Feb 2024 | 238.00 | CASCADE CARE | Not denied | — |
| CLM0003426 | 16 Jan 2024 | 812.00 | CASCADE CARE | Not denied | — |