CARLA NGUYEN
Dependent on policy B10M000125
Claims
1
Attributed to this person
Charged
612.00
Total submitted
Denied
612.00
1 denied claims
Patient responsibility
0.00
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 | B10M000125 |
| Date of birth | 28 Jan 2001 |
| Plan | SILVER HMO |
| Covered from | 26 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000533 | 27 Jul 2024 | 612.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 612.00 |