MARCUS NGUYEN
Dependent on policy B04M000894
Claims
3
Attributed to this person
Charged
905.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
64.80
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 | MARCUS NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000894 |
| Date of birth | 18 Feb 1954 |
| Plan | GOLD PPO |
| Covered from | 29 Apr 2025 |
| Covered to | 15 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| CARC 2 · Coinsurance | 1 | 14.80 |
| Total | 64.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003884 | 24 Nov 2025 | 753.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003885 | 8 Sep 2025 | 74.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003883 | 27 May 2025 | 78.00 | NORTHSTAR MUTUAL | Not denied | — |