DAVID CHEN
Subscriber on policy B10M000317
Claims
1
Attributed to this person
Charged
386.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
250.90
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 | B10M000317 |
| Date of birth | 29 Nov 1975 |
| Plan | PLATINUM PPO |
| Covered from | 23 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 250.90 |
| Total | 250.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001331 | 12 Jan 2025 | 386.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |