LEILA NGUYEN
Dependent on policy B04M000459
Claims
2
Attributed to this person
Charged
803.00
Total submitted
Denied
527.00
1 denied claims
Patient responsibility
0.00
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 | LEILA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000459 |
| Date of birth | 22 Oct 2021 |
| Plan | PLATINUM PPO |
| Covered from | 1 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001969 | 24 Jul 2024 | 527.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 527.00 |
| CLM0001968 | 14 Apr 2024 | 276.00 | NORTHSTAR MUTUAL | Not denied | — |