TOMAS NGUYEN
Dependent on policy B02M000232
Claims
1
Attributed to this person
Charged
631.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | TOMAS NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000232 |
| Date of birth | 25 Aug 1990 |
| Plan | SILVER HMO |
| Covered from | 20 Mar 2024 |
| Covered to | 4 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001021 | 8 Jun 2024 | 631.00 | MERIDIAN HEALTH PLAN | Not denied | — |