CARLA NGUYEN
Dependent on policy B01M000211
Claims
3
Attributed to this person
Charged
1,123.00
Total submitted
Denied
138.36
1 denied claims
Patient responsibility
50.00
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 | CARLA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000211 |
| Date of birth | 4 Feb 1994 |
| 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 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000892 | 28 Jan 2026 | 440.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 138.36 |
| CLM0000893 | 31 Aug 2025 | 123.00 | CASCADE CARE | Not denied | — |
| CLM0000894 | 21 Dec 2024 | 560.00 | CASCADE CARE | Not denied | — |