LEILA NGUYEN
Dependent on policy B01M000211
Claims
3
Attributed to this person
Charged
1,561.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | LEILA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000211 |
| Date of birth | 19 Jan 1958 |
| Plan | GOLD PPO |
| Covered from | 14 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000890 | 23 Aug 2026 | 371.00 | CASCADE CARE | Not denied | — |
| CLM0000891 | 10 Jul 2026 | 550.00 | CASCADE CARE | Not denied | — |
| CLM0000889 | 15 Jan 2025 | 640.00 | CASCADE CARE | Not denied | — |