OMAR CHEN
Dependent on policy B04M000888
Claims
1
Attributed to this person
Charged
416.00
Total submitted
Denied
416.00
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 | OMAR CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000888 |
| Date of birth | 21 Apr 1992 |
| Plan | GOLD PPO |
| Covered from | 26 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 |
|---|---|---|---|---|---|
| CLM0003849 | 22 Dec 2025 | 416.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 416.00 |