ELENA NGUYEN
Subscriber on policy B09M000452
Claims
3
Attributed to this person
Charged
1,896.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
550.10
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 | ELENA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B09M000452 |
| Date of birth | 26 Oct 2001 |
| Plan | PLATINUM PPO |
| Covered from | 1 Apr 2024 |
| Covered to | 19 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 373.10 |
| CARC 2 · Coinsurance | 1 | 177.00 |
| Total | 550.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001895 | 9 Oct 2024 | 437.00 | CASCADE CARE | Not denied | — |
| CLM0001893 | 12 Aug 2024 | 574.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001894 | 12 May 2024 | 885.00 | CASCADE CARE | Not denied | — |