DAVID NGUYEN
Subscriber on policy B08M000082
Claims
3
Attributed to this person
Charged
579.00
Total submitted
Denied
223.00
1 denied claims
Patient responsibility
15.75
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 | Subscriber |
| Policy | B08M000082 |
| Date of birth | 27 Nov 1996 |
| Plan | BRONZE EPO |
| Covered from | 23 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 15.75 |
| Total | 15.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000357 | 4 Oct 2025 | 223.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 223.00 |
| CLM0000358 | 14 May 2025 | 251.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000356 | 25 Dec 2024 | 105.00 | NORTHSTAR MUTUAL | Not denied | — |