CARLA CHEN
Dependent on policy B10M000459
Claims
1
Attributed to this person
Charged
219.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
142.35
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 | Dependent · relationship 01 |
| Policy | B10M000459 |
| Date of birth | 15 Feb 1983 |
| Plan | PLATINUM PPO |
| Covered from | 3 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 142.35 |
| Total | 142.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001902 | 30 Dec 2024 | 219.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |