ELENA NGUYEN
Dependent on policy B03M000095
Claims
3
Attributed to this person
Charged
1,689.00
Total submitted
Denied
285.23
2 denied claims
Patient responsibility
315.90
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 | ELENA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000095 |
| Date of birth | 1 Jan 1968 |
| Plan | PLATINUM PPO |
| Covered from | 22 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 315.90 |
| Total | 315.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000391 | 15 Mar 2026 | 486.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000392 | 7 Feb 2026 | 306.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000390 | 3 Sep 2025 | 897.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 285.23 |