RAVI NGUYEN
Subscriber on policy B04M000023
Claims
3
Attributed to this person
Charged
1,988.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
116.20
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 | RAVI NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000023 |
| Date of birth | 31 Jul 1998 |
| Plan | SILVER HMO |
| Covered from | 17 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 116.20 |
| Total | 116.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000098 | 12 May 2025 | 739.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000099 | 5 Jan 2025 | 581.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000100 | 8 Jun 2024 | 668.00 | MERIDIAN HEALTH PLAN | Not denied | — |