LEILA NGUYEN
Dependent on policy B04M000130
Claims
2
Attributed to this person
Charged
1,655.00
Total submitted
Denied
788.00
1 denied claims
Patient responsibility
130.05
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 | LEILA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000130 |
| Date of birth | 14 May 1975 |
| Plan | PLATINUM PPO |
| Covered from | 23 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 130.05 |
| Total | 130.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000597 | 4 May 2026 | 867.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000596 | 25 Dec 2025 | 788.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 788.00 |