TOMAS CHEN
Dependent on policy B04M000549
Claims
3
Attributed to this person
Charged
1,351.00
Total submitted
Denied
233.00
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 01 |
| Policy | B04M000549 |
| Date of birth | 15 Jul 1992 |
| Plan | PLATINUM PPO |
| Covered from | 6 May 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002427 | 10 Jun 2026 | 353.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002426 | 21 Sep 2025 | 765.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002425 | 1 Jun 2025 | 233.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 233.00 |