CARLA CHEN
Subscriber on policy B04M000381
Claims
3
Attributed to this person
Charged
904.00
Total submitted
Denied
273.00
1 denied claims
Patient responsibility
0.00
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 | CARLA CHEN |
| Role on the policy | Subscriber |
| Policy | B04M000381 |
| Date of birth | 20 Nov 1965 |
| Plan | BRONZE EPO |
| Covered from | 7 Aug 2024 |
| Covered to | 14 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001627 | 26 Jan 2025 | 549.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001628 | 1 Nov 2024 | 82.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001629 | 1 Aug 2024 | 273.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 273.00 |