TOMAS CHEN
Dependent on policy B10M000066
Claims
3
Attributed to this person
Charged
1,463.00
Total submitted
Denied
816.00
1 denied claims
Patient responsibility
22.20
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 | TOMAS CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000066 |
| Date of birth | 9 Apr 1987 |
| Plan | GOLD PPO |
| Covered from | 11 Jan 2025 |
| Covered to | 6 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 22.20 |
| Total | 22.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000266 | 24 Mar 2025 | 111.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000264 | 2 Mar 2025 | 536.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000265 | 18 Jan 2025 | 816.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 816.00 |