DAVID CHEN
Dependent on policy B02M000220
Claims
3
Attributed to this person
Charged
1,673.00
Total submitted
Denied
763.00
1 denied claims
Patient responsibility
25.00
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 | DAVID CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000220 |
| Date of birth | 4 Feb 1980 |
| Plan | SILVER HMO |
| Covered from | 17 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000959 | 29 Jan 2026 | 555.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000961 | 27 Sep 2025 | 355.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000960 | 19 Jan 2025 | 763.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 763.00 |