ELENA NGUYEN
Dependent on policy B10M000016
Claims
3
Attributed to this person
Charged
1,044.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
107.00
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 | ELENA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000016 |
| Date of birth | 25 Feb 1988 |
| Plan | BRONZE EPO |
| Covered from | 12 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 107.00 |
| Total | 107.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000064 | 29 Jun 2026 | 535.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000063 | 24 Apr 2026 | 240.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000062 | 25 Sep 2025 | 269.00 | MERIDIAN HEALTH PLAN | Not denied | — |