VICTOR NGUYEN
Subscriber on policy B04M000894
Claims
3
Attributed to this person
Charged
1,370.00
Total submitted
Denied
342.00
1 denied claims
Patient responsibility
55.05
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 | VICTOR NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000894 |
| Date of birth | 18 Aug 1955 |
| Plan | GOLD PPO |
| Covered from | 29 Apr 2025 |
| Covered to | 15 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.05 |
| Total | 55.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003882 | 23 Aug 2025 | 661.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003881 | 10 Apr 2025 | 342.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 342.00 |
| CLM0003880 | 6 Apr 2025 | 367.00 | NORTHSTAR MUTUAL | Not denied | — |