HENRY CHEN
Dependent on policy B04M000768
Claims
3
Attributed to this person
Charged
1,687.00
Total submitted
Denied
847.00
2 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 | HENRY CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000768 |
| Date of birth | 4 Aug 1989 |
| Plan | GOLD PPO |
| Covered from | 19 Jul 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 |
|---|---|---|---|---|---|
| CLM0003339 | 1 Sep 2025 | 713.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 713.00 |
| CLM0003340 | 9 Jun 2025 | 134.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 134.00 |
| CLM0003341 | 17 Feb 2025 | 840.00 | NORTHSTAR MUTUAL | Not denied | — |