TOMAS CHEN
Dependent on policy B02M000222
Claims
2
Attributed to this person
Charged
821.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
56.85
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 | B02M000222 |
| Date of birth | 3 Apr 1974 |
| Plan | BRONZE EPO |
| Covered from | 22 Jul 2024 |
| Covered to | 4 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 56.85 |
| Total | 56.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000970 | 2 Jan 2025 | 379.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000969 | 11 Nov 2024 | 442.00 | MERIDIAN HEALTH PLAN | Not denied | — |