TOMAS NGUYEN
Subscriber on policy B10M000046
Claims
3
Attributed to this person
Charged
863.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
100.20
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 | TOMAS NGUYEN |
| Role on the policy | Subscriber |
| Policy | B10M000046 |
| Date of birth | 20 Oct 1965 |
| Plan | BRONZE EPO |
| Covered from | 30 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 100.20 |
| Total | 100.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000172 | 7 Feb 2025 | 139.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000170 | 26 Aug 2024 | 223.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000171 | 31 Dec 2023 | 501.00 | NORTHSTAR MUTUAL | Not denied | — |