DAVID NGUYEN
Dependent on policy B07M000024
Claims
3
Attributed to this person
Charged
1,499.00
Total submitted
Denied
665.00
2 denied claims
Patient responsibility
239.85
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 | DAVID NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000024 |
| Date of birth | 10 Jan 2022 |
| Plan | PLATINUM PPO |
| Covered from | 3 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 239.85 |
| Total | 239.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000111 | 26 Feb 2026 | 465.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000109 | 2 Feb 2026 | 369.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000110 | 21 Oct 2025 | 665.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 665.00 |