CARLA NGUYEN
Subscriber on policy B03M000503
Claims
2
Attributed to this person
Charged
799.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
53.95
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 | CARLA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B03M000503 |
| Date of birth | 20 Jun 1985 |
| Plan | BRONZE EPO |
| Covered from | 9 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 53.95 |
| Total | 53.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002080 | 6 Jul 2025 | 83.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002079 | 4 Jun 2025 | 716.00 | NORTHSTAR MUTUAL | Not denied | — |