TOMAS CHEN
Dependent on policy B02M000418
Claims
3
Attributed to this person
Charged
2,152.00
Total submitted
Denied
523.00
1 denied claims
Patient responsibility
121.05
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 19 |
| Policy | B02M000418 |
| Date of birth | 4 Sep 1992 |
| Plan | GOLD PPO |
| Covered from | 21 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 121.05 |
| Total | 121.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001789 | 1 Apr 2025 | 523.00 | CASCADE CARE | CARC 96 · NON_COVERED | 523.00 |
| CLM0001788 | 19 Dec 2024 | 807.00 | CASCADE CARE | Not denied | — |
| CLM0001790 | 14 Feb 2024 | 822.00 | CASCADE CARE | Not denied | — |