DAVID CHEN
Dependent on policy B05M000117
Claims
2
Attributed to this person
Charged
693.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.40
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 | DAVID CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000117 |
| Date of birth | 6 Mar 1987 |
| Plan | BRONZE EPO |
| Covered from | 20 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 30.40 |
| Total | 30.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000485 | 22 Mar 2026 | 152.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000484 | 8 Feb 2025 | 541.00 | NORTHSTAR MUTUAL | Not denied | — |