AMARA NGUYEN
Subscriber on policy B07M000573
Claims
3
Attributed to this person
Charged
1,421.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
117.90
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 | AMARA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B07M000573 |
| Date of birth | 16 Jun 1965 |
| Plan | PLATINUM PPO |
| Covered from | 26 Apr 2024 |
| Covered to | 1 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 117.90 |
| Total | 117.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002428 | 21 Jul 2024 | 786.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002427 | 16 Jun 2024 | 150.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002426 | 28 Apr 2024 | 485.00 | NORTHSTAR MUTUAL | Not denied | — |