OMAR NGUYEN
Dependent on policy B01M000765
Claims
3
Attributed to this person
Charged
1,435.00
Total submitted
Denied
597.00
1 denied claims
Patient responsibility
19.60
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 | OMAR NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000765 |
| Date of birth | 20 Jul 1953 |
| Plan | SILVER HMO |
| Covered from | 30 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 19.60 |
| Total | 19.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003403 | 18 Sep 2025 | 98.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003404 | 27 Jan 2025 | 740.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003402 | 12 Dec 2024 | 597.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 597.00 |