AMARA CHEN
Subscriber on policy B05M000220
Claims
3
Attributed to this person
Charged
1,968.00
Total submitted
Denied
197.45
1 denied claims
Patient responsibility
216.00
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 | AMARA CHEN |
| Role on the policy | Subscriber |
| Policy | B05M000220 |
| Date of birth | 19 Jan 1966 |
| Plan | GOLD PPO |
| Covered from | 22 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 2 | 216.00 |
| Total | 216.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000911 | 10 Jan 2026 | 308.00 | CASCADE CARE | Not denied | — |
| CLM0000910 | 30 Jan 2025 | 772.00 | CASCADE CARE | Not denied | — |
| CLM0000912 | 16 Sep 2024 | 888.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 197.45 |