DAVID NGUYEN
Dependent on policy B03M000007
Claims
3
Attributed to this person
Charged
670.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
148.20
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 | DAVID NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000007 |
| Date of birth | 27 Jul 1978 |
| Plan | BRONZE EPO |
| Covered from | 24 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 148.20 |
| Total | 148.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000042 | 5 Sep 2025 | 228.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000041 | 25 Jul 2025 | 367.00 | CASCADE CARE | Not denied | — |
| CLM0000043 | 15 Apr 2025 | 75.00 | CASCADE CARE | Not denied | — |