BRIAN CHEN
Dependent on policy B01M000483
Claims
3
Attributed to this person
Charged
1,544.00
Total submitted
Denied
866.00
1 denied claims
Patient responsibility
10.50
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 | BRIAN CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000483 |
| Date of birth | 25 May 2007 |
| Plan | BRONZE EPO |
| Covered from | 8 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 10.50 |
| Total | 10.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002152 | 18 Apr 2025 | 608.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002153 | 13 Apr 2025 | 70.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002154 | 26 Dec 2023 | 866.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 866.00 |