SOFIA CHEN
Subscriber on policy B05M000696
Claims
3
Attributed to this person
Charged
488.00
Total submitted
Denied
79.75
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 | SOFIA CHEN |
| Role on the policy | Subscriber |
| Policy | B05M000696 |
| Date of birth | 14 Aug 2001 |
| Plan | BRONZE EPO |
| Covered from | 27 Mar 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002995 | 12 May 2024 | 152.00 | CASCADE CARE | Not denied | — |
| CLM0002997 | 1 May 2024 | 234.00 | CASCADE CARE | CARC 18 · DUPLICATE | 79.75 |
| CLM0002996 | 11 Apr 2024 | 102.00 | CASCADE CARE | Not denied | — |