LEILA CHEN
Dependent on policy B03M000340
Claims
2
Attributed to this person
Charged
1,722.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
536.25
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 | Dependent · relationship 01 |
| Policy | B03M000340 |
| Date of birth | 28 Mar 1948 |
| Plan | BRONZE EPO |
| Covered from | 10 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 536.25 |
| Total | 536.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001368 | 9 Mar 2026 | 825.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001369 | 5 Sep 2025 | 897.00 | NORTHSTAR MUTUAL | Not denied | — |