HENRY NGUYEN
Dependent on policy B03M000847
Claims
3
Attributed to this person
Charged
1,525.00
Total submitted
Denied
449.00
1 denied claims
Patient responsibility
48.30
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 | HENRY NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000847 |
| Date of birth | 5 Sep 1975 |
| Plan | SILVER HMO |
| Covered from | 27 Apr 2024 |
| Covered to | 22 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 48.30 |
| Total | 48.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003671 | 7 Jan 2025 | 449.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 449.00 |
| CLM0003669 | 30 Jul 2024 | 322.00 | CASCADE CARE | Not denied | — |
| CLM0003670 | 6 Jun 2024 | 754.00 | CASCADE CARE | Not denied | — |