DAVID NGUYEN
Dependent on policy B07M000849
Claims
1
Attributed to this person
Charged
104.00
Total submitted
Denied
25.75
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 | DAVID NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000849 |
| Date of birth | 3 Dec 2011 |
| Plan | BRONZE EPO |
| Covered from | 7 Sep 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 |
|---|---|---|---|---|---|
| CLM0003499 | 3 Oct 2024 | 104.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 25.75 |