YUSUF CHEN
Subscriber on policy B01M000425
Claims
2
Attributed to this person
Charged
892.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
79.95
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 | YUSUF CHEN |
| Role on the policy | Subscriber |
| Policy | B01M000425 |
| Date of birth | 7 Feb 1964 |
| Plan | GOLD PPO |
| Covered from | 15 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 79.95 |
| Total | 79.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001874 | 15 Jan 2026 | 123.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001875 | 14 May 2025 | 769.00 | NORTHSTAR MUTUAL | Not denied | — |