OMAR NGUYEN
Subscriber on policy B02M000617
Claims
3
Attributed to this person
Charged
1,915.00
Total submitted
Denied
826.00
1 denied claims
Patient responsibility
124.80
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 | OMAR NGUYEN |
| Role on the policy | Subscriber |
| Policy | B02M000617 |
| Date of birth | 17 Nov 1965 |
| Plan | BRONZE EPO |
| Covered from | 16 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 124.80 |
| Total | 124.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002591 | 31 Mar 2026 | 257.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002593 | 19 Dec 2024 | 832.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002592 | 9 Nov 2024 | 826.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 826.00 |