ELENA CHEN
Dependent on policy B04M000469
Claims
3
Attributed to this person
Charged
1,668.00
Total submitted
Denied
754.00
2 denied claims
Patient responsibility
475.30
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 | ELENA CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000469 |
| Date of birth | 7 Aug 2002 |
| Plan | SILVER HMO |
| Covered from | 18 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 422.50 |
| CARC 2 · Coinsurance | 1 | 52.80 |
| Total | 475.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002008 | 5 Jun 2026 | 264.00 | CASCADE CARE | Not denied | — |
| CLM0002009 | 26 Nov 2025 | 754.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 754.00 |
| CLM0002010 | 27 Oct 2025 | 650.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |