FIONA NGUYEN
Dependent on policy B04M000230
Claims
3
Attributed to this person
Charged
1,734.00
Total submitted
Denied
135.00
1 denied claims
Patient responsibility
145.00
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 | FIONA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000230 |
| Date of birth | 1 Nov 2013 |
| Plan | BRONZE EPO |
| Covered from | 21 Aug 2024 |
| Covered to | 4 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 145.00 |
| Total | 145.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001008 | 29 Aug 2024 | 725.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001010 | 29 Aug 2024 | 135.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 135.00 |
| CLM0001009 | 22 Jul 2024 | 874.00 | MERIDIAN HEALTH PLAN | Not denied | — |