TOMAS CHEN
Dependent on policy B04M000500
Claims
2
Attributed to this person
Charged
1,252.00
Total submitted
Denied
559.00
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 | TOMAS CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000500 |
| Date of birth | 19 Mar 2016 |
| Plan | PLATINUM PPO |
| Covered from | 6 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002151 | 29 Nov 2025 | 693.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002152 | 29 Apr 2025 | 559.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 559.00 |