TOMAS CHEN
Subscriber on policy B02M000096
Claims
1
Attributed to this person
Charged
765.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
153.00
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 | TOMAS CHEN |
| Role on the policy | Subscriber |
| Policy | B02M000096 |
| Date of birth | 11 Jun 1959 |
| Plan | PLATINUM PPO |
| Covered from | 24 Nov 2024 |
| Covered to | 15 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 153.00 |
| Total | 153.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000437 | 21 May 2025 | 765.00 | CASCADE CARE | Not denied | — |