FIONA NGUYEN
Subscriber on policy B08M000769
Claims
3
Attributed to this person
Charged
1,663.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
614.10
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 | FIONA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B08M000769 |
| Date of birth | 6 Mar 1976 |
| Plan | PLATINUM PPO |
| Covered from | 6 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 518.70 |
| CARC 1 · Deductible | 1 | 95.40 |
| Total | 614.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003443 | 21 Apr 2026 | 798.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003442 | 10 Feb 2026 | 636.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003441 | 30 Jan 2025 | 229.00 | NORTHSTAR MUTUAL | Not denied | — |