LEILA CHEN
Subscriber on policy B02M000601
Claims
3
Attributed to this person
Charged
1,639.00
Total submitted
Denied
1,063.00
3 denied claims
Patient responsibility
374.40
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 | LEILA CHEN |
| Role on the policy | Subscriber |
| Policy | B02M000601 |
| Date of birth | 3 Sep 1987 |
| Plan | GOLD PPO |
| Covered from | 8 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 374.40 |
| Total | 374.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002524 | 17 Oct 2025 | 576.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002525 | 19 Aug 2025 | 773.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 773.00 |
| CLM0002526 | 19 Apr 2025 | 290.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 290.00 |