ELENA CHEN
Subscriber on policy B10M000428
Claims
3
Attributed to this person
Charged
1,008.00
Total submitted
Denied
628.00
3 denied claims
Patient responsibility
247.00
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 | ELENA CHEN |
| Role on the policy | Subscriber |
| Policy | B10M000428 |
| Date of birth | 11 Jan 2000 |
| Plan | BRONZE EPO |
| Covered from | 2 Apr 2025 |
| Covered to | 10 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 247.00 |
| Total | 247.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001780 | 3 Jul 2025 | 323.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 323.00 |
| CLM0001778 | 7 Jun 2025 | 380.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0001779 | 12 Mar 2025 | 305.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 305.00 |