UMA NGUYEN
Subscriber on policy B10M000674
Claims
1
Attributed to this person
Charged
581.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
377.65
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 | UMA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B10M000674 |
| Date of birth | 18 Mar 1995 |
| Plan | GOLD PPO |
| Covered from | 2 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 377.65 |
| Total | 377.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002792 | 30 Dec 2024 | 581.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |