ZARA NGUYEN
Subscriber on policy B04M000221
Claims
3
Attributed to this person
Charged
1,091.00
Total submitted
Denied
144.81
1 denied claims
Patient responsibility
14.20
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 | ZARA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000221 |
| Date of birth | 4 May 2002 |
| Plan | GOLD PPO |
| Covered from | 26 Mar 2025 |
| Covered to | 18 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 14.20 |
| Total | 14.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000974 | 13 Sep 2025 | 593.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000973 | 1 Aug 2025 | 427.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 144.81 |
| CLM0000975 | 6 May 2025 | 71.00 | NORTHSTAR MUTUAL | Not denied | — |