VICTOR CHEN
Dependent on policy B03M000151
Claims
2
Attributed to this person
Charged
1,253.00
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 | VICTOR CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000151 |
| Date of birth | 21 Nov 1996 |
| Plan | PLATINUM PPO |
| Covered from | 13 Jul 2024 |
| Covered to | open |
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 |
|---|---|---|---|---|---|
| CLM0000619 | 25 Nov 2025 | 765.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000618 | 18 Nov 2024 | 488.00 | NORTHSTAR MUTUAL | Not denied | — |